A study on the optimal dose of aspirin therapy in Kawasaki disease. Clinical evaluation and arachidonic acid metabolism.

Aspirin is the basic treatment for Kawasaki disease, however its optimal dose is controversial. We investigated the therapeutic efficacy of high-dose (100 mg/kg/day, n = 30) versus low-dose (30 mg/kg/day, n = 30) aspirin. Duration of fever, transaminase, plasma thromboxane B2 (TxB2) and 6-keto-prostaglandin F1 alpha (PGF1 alpha) levels were compared before enrollment and on days 4, 7 and 14. In the high-dose group, duration of fever was significantly shorter than that of low-dose group (3.2 +/- 1.8 versus 5.4 +/- 4.3 days, p less than 0.05), however, serum glutamic pyruvic transaminase levels were elevated (157.4 +/- 187.7 versus 48.0 +/- 58.2I.U./liter, p less than 0.005). No differences in the incidence of coronary artery lesions were observed (5 of 30 versus 7 of 30). Plasma TxB2 production was completely blocked in both groups, plasma 6-keto-PGF1 alpha levels in the high-dose group on day 14 was lower than that in the low-dose group (39 +/- 26 versus 160 +/- 207 pg/ml, p less than 0.05). This latter observation suggest that high-dose therapy may be disadvantageous as anti-thrombotic treatment, and supports the notion that low dose therapy is safe in the acute stage of Kawasaki disease.