Ticlopidine Plus Aspirin for Coronary Thrombosis in Kawasaki Disease

O’Brien, Maureen M.; Parness, Ira A.; Neufeld, Ellis J.; Baker, Annette L.; Sundel, Robert P.

doi:10.1542/peds.105.5.e64

Cited by 21 publications

(10 citation statements)

References 13 publications

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“…Agents that act via the glycoprotein IIb/IIIa receptor pathway have previously been reported to treat thrombi in Kawasaki patients successfully. 8,9 In addition to this property, however, abciximab has other pharmacological properties that may be useful in Kawasaki disease. 7 First, it binds to vitronectin receptors and may impede adhesion of vascular smooth muscle cells to the receptor ligands at the site of vascular inflammation.…”

Section: Discussionmentioning

confidence: 99%

“…Abciximab is a glycoprotein IIb/IIIa receptor inhibitor that has been shown to prevent thrombotic complications and promote vascular remodeling in adults with acute coronary artery syndromes. 7 Although drugs that affect the glycoprotein IIb/IIIa receptor pathway have been used for thrombolysis in Kawasaki disease, 8,9 their effect on vascular remodeling has not been reported. After rapid regression of large coronary artery aneurysms was noted in a patient after use of abciximab for thrombolysis at our institution, 8 we began using this agent as part of initial therapy in patients who have acute Kawasaki disease and present with large aneurysms with or without evidence of intracoronary thrombus.…”

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confidence: 99%

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Does Abciximab Enhance Regression of Coronary Aneurysms Resulting From Kawasaki Disease?

et al. 2002

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ABSTRACT. Objective. Acute Kawasaki disease can result in the development of large coronary artery aneurysms that may persist. Abciximab, a platelet glycoprotein IIb/IIIa receptor inhibitor, is associated with resolution of thrombi and vascular remodeling in adults with acute coronary syndromes. The purpose of this study was to compare changes in aneurysm diameter at early follow-up in patients who had Kawasaki disease and received abciximab in addition to standard therapy with those who were treated with standard therapy alone.Methods. Patients with Kawasaki disease and large aneurysms were divided into 2 groups on the basis of acute therapy: 1) abciximab in addition to standard therapy and 2) standard therapy alone. Echocardiograms were reviewed for coronary aneurysms (lumen diameter 1.5 times that of the adjacent vessel). Maximum aneurysm diameter was determined during the acute/subacute phase of Kawasaki disease (<6 weeks) and at early follow-up (4 -6 months). Regression of the aneurysm was defined as a decrease in lumen diameter, and resolution was defined as normalization of the vessel.Results. Six patients had 20 aneurysms in the abciximab group, and 9 patients had 30 aneurysms in the standard therapy group. Early follow-up data were available for 19 of the 20 aneurysms in the abciximab group and 19 of the 30 aneurysms in the standard therapy group. Patients who were treated with abciximab demonstrated greater regression in aneurysm size at early follow-up than patients who were treated with standard therapy alone (percentage decrease: 41 ؎ 19% vs 17 ؎ 27%). In the abciximab group, 68% (13 of 19) of aneurysms resolved at early follow-up compared with 35% (7 of 19) in the standard therapy group.Conclusions. Patients who were treated with abciximab demonstrated greater regression in aneurysm diameter at early follow-up than patients who received standard therapy alone. These findings suggest that treatment with abciximab may promote vascular remodeling in this population and warrants further study. Pediatrics 2002;109(1). URL: http://www.pediatrics.org/ cgi/content/full/109/1/e4; Kawasaki disease, coronary artery abnormalities, abciximab.

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Section: Discussionmentioning

confidence: 99%

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confidence: 99%

Does Abciximab Enhance Regression of Coronary Aneurysms Resulting From Kawasaki Disease?

et al. 2002

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“…En casos de aneurismas coronarios gigantes complicados con trombosis, refractarios al tratamiento trombolítico usual, se utilizan inhibidores selectivos de la adenosina 5-difosfato de la vía de activación plaquetaria como el ticlopidine en asociación con la aspirina con buenos resultados (48).…”

Section: Discusionunclassified

Enfermedad de Kawasaki: un caso con pseudo-obstrucción intestinal y aneurisma gigante

Tori¹,

Galgani²

2015

Rev Med Hered

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SUMMARYWe present a rare association of Kawasaki disease in a two year old boy presenting with fever, a morbiliform rash and clinical signs of intestinal pseudo-obstruction. Our patient subsequently developed a giant aneurysm of the right coronary artery complicated with thrombosis. He presented fever again 48 hours after the first dose of Immunoglobulin and needed a second one with good results. These patients with giant coronary aneurysms have a greater risk of developing stenosis and myocardial infarction, and require anticoagulant therapy, frequent stress scans and coronary angiographies. Those who developed less severe disease need only antiplatelet therapy and less frequent cardiovascular tests. Patients with a normal echocardiogram after the acute phase of the disease are not treated. The long-term prognosis of this disease is uncertain, especially regarding the possible association with coronary disease in adult life. (Rev Med Hed 2002; 13: 114-122).KEY WORDS: Kawasaki, mucocutaneous lymph node syndrome, vasculitis, pseudoobstruction, coronaryaneurysms. INTRODUCCIÓNPresentamos a un paciente varón de dos años de edad con Enfermedad de Kawasaki y secuelas cardiovasculares. Se presentó como un cuadro febril, signos abdominales sugestivos de un cuadro suboclusivo intestinal y un rash morbiliforme en el cuerpo. Durante su evolución inmediata los tramos iniciales de las dos arterias coronarias principales fueron aumentando de tamaño hasta convertirse la arteria coronaria derecha en un aneurisma gigante de 9.7 mm de diámetro, que desarrolló un trombo aunque sin mayores complicaciones.Debido a su compromiso cardiovascular, nuestro paciente presenta un gran riesgo de desarrollar estenosis coronaria, razón por la cual tiene que ser evaluado periódicamente.A pesar que la Enfermedad de Kawasaki es una enfermedad poco común, sin embargo, su forma de presentación y los signos y síntomas que presenta, la hacen confundirse con otras enfermedades más usuales, lo que hace que se demore o no se haga el diagnóstico a tiempo y poder así evitar secuelas tan importantes como el aneurisma gigante que presentó este paciente a pesar que el diagnóstico fue hecho con prontitud. Caso Clínico:Paciente varón de 2 años de edad, con historia de fiebre alta, dolor abdominal y constipación. Se inicia con dolor abdominal difuso tipo cólico, dos días antes de su ingreso y que fué aumentando en intensidad en las 24 horas previas a su ingreso. No eliminaba flatos y no había

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“…There have been isolated case reports of successful use of ticlopidine in children with Kawasaki disease 38 …”

Section: Children and Infantsmentioning

confidence: 99%

Ticlopidine

Dusitanond¹,

Hankey²

2004

The Journal of Drug Evaluation

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Ticlopidine is an antiplatelet drug which inhibits the adenosine diphosphate (ADP) receptor on platelets, and thereby reduces platelet activation and aggregration, and subsequent serious vascular events in patients at risk of thrombotic events. ChemistryThe chemical name of ticlopidine hydrochloride is 5-[(2-Chlorophenyl)-methyl]-4,5,6,7-tetrahydrothieno [3,2-c] pyridinehydrochloride.The empirical formula of ticlopidine hydrochloride is C 14 H 14 ClNS-HCl ( Figure 1).Ticlopidine is a thienopyridine derivative and has a thienopyridine ring in its structure. It has a molecular weight of 300.25 daltons. It is a white crystalline powder which is freely soluble in water and methanol.It is sparingly soluble in methylene chloride, ethanol and buffer solutions above pH 6.0 and slightly soluble in acetone. An aqueous solution of ticlopidine has a pH of 3.6. Pharmacokinetic propertiesAbsorption Approximately 80-90% of an oral dose of ticlopidine is absorbed in healthy volunteers 1 . Absorption of ticlopidine is improved when the drug is administered with food 2 . Plasma concentrationsSingle dose A single 250 mg dose of ticlopidine produces a peak plasma concentration (Cmax) of between 0.31 and 0.70 mg/L at 1.7-2.0 h after administration in healthy volunteers 3-5 . Administration of a single 250 mg dose of [ 14 C]-ticlopidine in untreated subjects realises only 5% of the area under the plasma concentration-time curve (AUC) for plasma radioactivity during the first 8 h after administration. Repeated dosesRepeated doses of 250 mg bid of ticlopidine given to healthy volunteers produces steady-state plasma concentrations after 5-14 days, and values for Cmax of 0.89-1.42 mg/L 5,6 . After multiple dosing with nonlabeled ticlopidine, the proportion of ticlopidine to total radioactivity in plasma increases to approximately 15% of plasma radioactivity over 8 h 4 . The increase in ticlopidine concentrations and the increased proportion of total radioactivity after multiple dosing suggests that metabolism of ticlopidine is saturated after chronic dosing. This finding is consistent with multiple-dose pharmacokinetic studies of ticlopidine 5 . Influence of food and antacidAdministration of a single 250 mg dose of ticlopidine together with food results in 11% less time to reach Cmax, and the values for Cmax and AUC are 20% higher, compared with administration of ticlopidine after fasting 7 . Administration of ticlopidine with food is recommended to maximize gastrointestinal tolerance.In contrast, administration of ticlopidine with an antacid results in a significant decrease in AUC but no change in the rate of absorption, compared with adminstration after fasting 7 .

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Ticlopidine Plus Aspirin for Coronary Thrombosis in Kawasaki Disease

Cited by 21 publications

References 13 publications

Does Abciximab Enhance Regression of Coronary Aneurysms Resulting From Kawasaki Disease?

Does Abciximab Enhance Regression of Coronary Aneurysms Resulting From Kawasaki Disease?

Enfermedad de Kawasaki: un caso con pseudo-obstrucción intestinal y aneurisma gigante

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