Comparative study of therapeutic effects according to duration of medium-dose aspirin therapy at the acute stage of Kawasaki disease

The mainstay of current standard therapy for acute-phase Kawasaki disease (KD) is intravenous immunoglobulin (IVIG) therapy at 2 g/kg. However, the efficacy of combining medium- or high-dose aspirin with IVIG therapy at 2 g/kg has not been fully investigated. Some studies suggested that aspirin may inhibit coronary artery lesion (CAL) prevention in IVIG therapy and that the delayed use of aspirin in IVIG therapy may be beneficial for the suppression of CALs and prevention of coronary artery stenosis in patients with KD. The efficacy of the delayed use of low-dose aspirin in IVIG therapy for acute-phase KD remains unclear. Therefore, this retrospective study aimed to assess the efficacy of the delayed use of low-dose aspirin, when combined with IVIG therapy for acute-phase KD. Data were obtained from 193 KD patients who underwent acute-phase treatment from January 2009 to October 2020 and IVIG therapy at 2 g/kg with the delayed use of aspirin/flurbiprofen. The patients were divided into three groups: (1) low-dose group, in which 40 patients received low-dose aspirin (5 mg/kg/day); (2) medium-dose group, in which 90 patients received medium-dose aspirin (30 mg/kg/day); and (3) flurbiprofen group, in which 63 patients received flurbiprofen (3–5 mg/kg/day). KD patients with liver damage or those present during influenza season underwent flurbiprofen therapy between January 2009 and November 2017. All patients except one received low-dose aspirin after December 2017. The serum albumin level (median 3.40 vs. 3.30 g/dL, P = 0.026) and Egami score (median 1.0 vs. 2.0, P < 0.001) before the initial treatment were significantly different between the medium-dose group and the flurbiprofen group. The rates of initial IVIG therapy resistance (25.0% vs. 18.9% vs. 25.4%, P = 0.790), rescue therapy (17.5% vs. 8.9% vs. 17.5%, P = 0.721), and CALs (5.0% vs. 0.0% vs. 4.8%, P = 0.713) were similar among the low-dose, medium-dose, and flurbiprofen groups. Overall, the efficacy of the delayed use of low-dose aspirin was similar to that of the delayed use of medium-dose aspirin/flurbiprofen in IVIG therapy for acute-phase KD.

Download Full-text

Comparative study of therapeutic effects of PPI and H2RA on ulcers during continuous aspirin therapy

World Journal of Gastroenterology ◽

10.3748/wjg.v16.i42.5342 ◽

2010 ◽

Vol 16 (42) ◽

pp. 5342 ◽

Cited By ~ 11

Author(s):

Hiroaki Nema

Keyword(s):

Comparative Study ◽

Aspirin Therapy ◽

Therapeutic Effects

Download Full-text

Faculty Opinions recommendation of Continuation of low-dose aspirin therapy in peptic ulcer bleeding: a randomized trial.

Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature ◽

10.3410/f.1256012.1603056 ◽

2010 ◽

Author(s):

Ian Beales

Keyword(s):

Peptic Ulcer ◽

Randomized Trial ◽

Low Dose ◽

Aspirin Therapy ◽

Ulcer Bleeding ◽

Peptic Ulcer Bleeding ◽

Dose Aspirin ◽

Low Dose Aspirin

Download Full-text

Faculty Opinions recommendation of Comparative study of the therapeutic effects of oral contraceptive pills containing desogestrel, cyproterone acetate, and drospirenone in patients with polycystic ovary syndrome.

Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature ◽

10.3410/f.717978515.793471100 ◽

2013 ◽

Author(s):

Richard Anderson ◽

Raymond Li

Keyword(s):

Oral Contraceptive ◽

Polycystic Ovary Syndrome ◽

Comparative Study ◽

Cyproterone Acetate ◽

Polycystic Ovary ◽

Therapeutic Effects ◽

Ovary Syndrome ◽

Oral Contraceptive Pills ◽

Contraceptive Pills

Download Full-text

Comparative study of the protective and therapeutic effects of Manuka and Saudi Sidr honey on experimentally induced gastric ulcer in rats

Materials Today Proceedings ◽

10.1016/j.matpr.2021.04.069 ◽

2021 ◽

Author(s):

Reem Alazragi ◽

Ghadeer Al-Ghamdi ◽

Rasha H. Hussein

Keyword(s):

Gastric Ulcer ◽

Comparative Study ◽

Therapeutic Effects ◽

Experimentally Induced

Download Full-text

Predictive value of brachial artery flow-mediated dilation on coronary artery abnormality in acute stage of Kawasaki disease

Scientific Reports ◽

10.1038/s41598-021-87704-y ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Yizhou Wen ◽

Xianmin Wang ◽

Yonghong Guo ◽

Mei Jin ◽

Jimei Xi ◽

...

Keyword(s):

Coronary Artery ◽

Kawasaki Disease ◽

Brachial Artery ◽

Characteristic Curve ◽

Coronary Aneurysm ◽

Acute Stage ◽

Flow Mediated Dilation ◽

Strong Negative Correlation ◽

Coronary Artery Abnormality ◽

Artery Flow

AbstractCoronary artery abnormalities (CAAs) are a severe complication of Kawasaki disease (KD) that may lead to cardiovascular events. Given the evidence that brachial artery flow-mediated dilation (FMD) decreases in children after the onset of KD, we hypothesized that it could be an early marker of CAA development in the acute stage and investigated its relationship with variation in the coronary artery diameter. A total of 326 sex- and age-matched children were enrolled, including 120 with KD, 109 febrile children and 97 healthy controls. In this study, FMD was significantly decreased in the KD group compared with the febrile and healthy groups. FMD was lower in the CAA group than in the no coronary artery abnormality group. The comparison of FMD showed an obvious difference among the CAA subgroups. The FMD in the coronary aneurysm (CA) group showed a strong negative correlation with the pretreatment maximum coronary artery Z-score (preZmax). While preZmax was 2.5, the receiver operating characteristic curve indicated an optimal cutoff point of 3.44% for FMD. FMD ≤ 3.44% could be considered as a signal of coronary lesions in acute stage of KD.

Download Full-text

Abstract 124: Patient Condition Adaptive Path System of Kawasaki Disease

Circulation ◽

10.1161/circ.131.suppl_2.124 ◽

2015 ◽

Vol 131 (suppl_2) ◽

Author(s):

Masako Fujiwara ◽

Tohru Kobayashi ◽

Satoko Tsuru ◽

Hiroyuki Ida

Keyword(s):

Kawasaki Disease ◽

Therapeutic Strategy ◽

Acute Stage ◽

Diagnostic Process ◽

Clinical Process ◽

Path System ◽

Overhead View ◽

Severity Of The Disease ◽

A Chain ◽

Japanese Guidelines

Background: In Japan, 2 guidelines are published, the clinical guidelines for medical treatment of acute stage Kawasaki disease(KD)(2012) and guidelines for diagnosis and management of cardiovascular sequelae in KD(2013). Patient Condition Adaptive Path System (PCAPS) is a technique to structure clinical knowledge. It places “patient condition” as a core, to which multiple “target conditions” are linked. On the other hand, patients of KD ware focused the severity of the disease and therapeutic strategy influences the improvement. Purpose: The purpose is confirming the PCAPS KD contents, which complied two Japanese Guidelines and to evaluate adaption of the contents. Methods: PCAPS content is composed of Clinical Process Chart (CPC) and Unit Sheet (US).CPC is an overhead view of clinical path consisting of a chain of units. CPC was made according the guidelines, and coronary evaluation, CHF, cardiac catheterization and ACS unit can activate on time. CPC stratify the patient’s severity. US are composed of specific healthcare tasks in a unit. Results: We confirm PCAPS KD contents on the base of 2 guidelines. We can evaluate diagnostic process and severity of KD by route analysis using CPC (figure). We can visualize relationship between treatments and severity by US. US are effective to support the decision on treatment and examinations. From the analysis, there are no lack of the unit and route, and confirm the advice to decision making. Conclusions: PCAPS can easily analyze the severity and clinical process from CPC route analysis because PCAPS is electrical path which can automatically store the data of each hospital. From US data, there are possibilities to find new severity score.

Download Full-text