Key result
Omitting aspirin is non-inferior to aspirin for preventing coronary artery lesions in acute Kawasaki disease.
Why the study?
Conflicting evidence exists regarding aspirin treatment and its clinical benefit in patients with acute Kawasaki disease.
Does aspirin at various doses reduce coronary artery lesions in patients with acute Kawasaki disease compared to no aspirin?
Meta-Analysis (n=1,944)
Does aspirin at various doses reduce coronary artery lesions in patients with acute Kawasaki disease compared to no aspirin?
Treatment without aspirin is not inferior to various doses of aspirin in reducing the risk of coronary artery lesions in acute Kawasaki disease.
Answers are grounded in this paper and cite their sources.
Omitting aspirin is noninferior for preventing coronary lesions in acute Kawasaki disease; challenges aspirin-inclusive guidelines and supports de-escalation trials.
Aspirin was once believed to reduce the mortality of Kawasaki disease (KD) due to its effect on the thrombotic occlusion of coronary arteries. However, conflicting evidence has been found regarding aspirin treatment and its benefit in patients with acute KD. We compared the efficacy of different aspirin doses in acute KD. A literature search of PubMed, EMBASE, and Cochrane databases was conducted to identify studies comparing different doses of aspirin for acute KD. The primary outcome of interest was coronary artery lesions (CAL). We used random-effects network meta-analysis. Six retrospective studies, including 1944 patients receiving aspirin in doses of 0, 3-5, 30-50, or 80-100 mg/kg/day, were selected. The risks of CAL were not significantly different for the various doses of aspirin compared to the placebo: odds ratio (OR) was 1.10 [95% confidence interval (CI): 0.70-1.71] for patients with aspirin 3-5 mg/kg/day; OR = 1.23 (95% CI: 0.67-2.26) for aspirin 30-50 mg/kg/day, and OR = 1.59 (95% CI: 0.74, 3.421) for 80-100 mg/kg/day. The P-score ranged from 0.76 for placebo to 0.19 for aspirin 80-100 mg/kg/day. The different doses of aspirin exhibited no significant difference with regard to the efficacy of CAL or with the secondary outcomes of intravenous immunoglobulin resistance or hospital stays for acute KD. Therefore, we found that treatment without any aspirin is not inferior to other doses of aspirin and can also slightly reduce the risk of CAL.
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Huang et al. (2021) conducted a meta-analysis in Kawasaki Disease (n=1,944). Aspirin vs. Placebo (0 mg/kg/day aspirin) was evaluated on Coronary artery lesions (CAL) (OR 1.10, 95% CI 0.70-1.71). Treatment without aspirin was not inferior to various doses of aspirin (3-5, 30-50, or 80-100 mg/kg/day) for preventing coronary artery lesions in patients with acute Kawasaki disease.
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