Antithrombotic Therapy in Children: Kawasaki s Disease
The effectiveness of heparin was assessed in one level I study and five level II studies. Three outcomes were assessed: patency, local thrombus, and ICH. Patency, which is likely linked to the presence of local thrombus, is prolonged by the use of low-dose heparin (one level I and four level II studies).Local thrombus, detected by ultrasound, was not decreased in two level II studies. The power, however, was low. ICH as an outcome was not increased in two level II studies. The sample size in one study, however, was small (15 per arm). In the other study, the odds ratio for ICH and heparin use was 1.49 (95% Cl, 0.62 to 3.59). In two level III studies, heparin was implicated as a risk factor for ICH in low-birth-weight infants. One study was retrospective, the 95% Cl around the odds ratio of 3.9 was large (1.4 to 11.0), and the magnitude of the risk was uncertain. The second study reported a positive correlation between heparin dose and frequency of ICH, although severity of illness was also positively correlated with heparin dose, and the effect could not be differentiated. Large, well-designed studies are required to determine whether low-dose heparin infusion affects the incidence of ICH. asthma medications inhalers
Kawasaki s Disease: In patients with Kawasaki’s disease, aspirin is initially given in high doses (80 to 100 mg/kg/d during the acute phase for up to 14 days) as an antiinflammatory agent, then in lower doses as an antiplatelet agent (3 to 5 mg/kg/d for 7 weeks or longer) to prevent coronary aneurysm thrombosis and subsequent infarction (the major cause of death in Kawasaki’s disease). Although no level I or level II studies have been performed, two level III studies suggest that aspirin can reduce the coronary involvement in Kawasaki’s disease. A recent metaanalysis concluded that children treated with IV 7-globulin and aspirin had a significantly lower incidence of coronary artery aneurysms than those treated with aspirin alone. Much of the treatment difference in this analysis was due to one level I study that demonstrated that the combination of IV 7-globulin and aspirin is more efficacious in this regard than is aspirin alone. The meta-analysis made a number of conclusions about optimal dosing of aspirin and gammaglobulin. Significant methodological flaws in the analysis, however, suggest that the conclusions should be viewed with some caution. Further studies are required.