Low-Dose vs High-Dose Aspirin: Which Is Best for Kawasaki Disease?

Low-dose acetylsalycilic acid (ASA) carries a higher risk of intravenous immunoglobulin (IVIG) resistance and need for retreatment compared with high-dose ASA in children being treated for Kawasaki disease (KD), according to a recent study.

A single infusion of 2g/kg IVIG is a well-known and established treatment for KD. However, the appropriate dose of ASA for this patient population is still unclear.
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For their study, the researchers assessed the charts of KD patients at 2 centers in Canada who had been treated with a standard dose of IVIG and either low-dose (3-5 mg/kg/day; n = 122) or high-dose ASA (80-100 mg/kg/day; n= 127) from diagnosis.

Results of the study indicated that 28 (23%) patients receiving low-dose ASA demonstrated IVIG resistance and required retreatment with a second dose of IVIG, compared with 11 (8.7%) patients receiving high-dose ASA. Following adjustment, low-dose ASA was ultimately found to be associated with a greater risk of IVIG resistance (odds ratio [OR] 3.2).

The researchers observed little difference between the first and second centers in regard to hospital length of stay (4.1 days vs 4.7 days) or the development of coronary artery aneurysms (2 of 117 vs 6 of 125).

“Low-dose ASA was associated with 3 times higher odds of IVIG re-treatment compared to high-dose ASA, with no significant difference in duration of hospital stay or incidence of coronary artery aneurysms,” the researchers concluded.

—Christina Vogt

Reference:

Dhanrajani A, Chan M, Pau S, Ellsworth J, Petty R, Guzman J. Aspirin dose in Kawasaki disease – the ongoing battle [Published online December 29, 2017]. Arthritis Care Res. doi:10.1002/acr.23504.