Key result
Apixaban shows no difference in new coronary thrombosis or bleeding vs conventional anticoagulation.
Why the study?
Anticoagulation combined with aspirin lowers the risk of coronary thrombosis in pediatric patients with large or giant coronary artery aneurysms after Kawasaki disease, motivating an evaluation of the safety and efficacy of apixaban compared with conventional anticoagulant therapy in this high-risk population.
Does apixaban combined with antiplatelet therapy reduce new coronary thrombosis, myocardial infarction, and clinically relevant bleeding compared to conventional anticoagulation in pediatric patients with large/giant coronary artery aneurysms following Kawasaki disease?
Observational (n=28)
No
Does apixaban combined with antiplatelet therapy reduce new coronary thrombosis, myocardial infarction, and clinically relevant bleeding compared to conventional anticoagulation in pediatric patients with large/giant coronary artery aneurysms following Kawasaki disease?
In a small single-center pediatric cohort with large or giant coronary artery aneurysms after Kawasaki disease, apixaban plus antiplatelet therapy showed comparable thrombotic and bleeding event rates to prior conventional anticoagulation.
Answers are grounded in this paper and cite their sources.
Apixaban may offer an oral option in Kawasaki aneurysms; leaves open need for prospective trials before practice change.
BACKGROUND: Anticoagulation combined with aspirin lowers the risk of coronary thrombosis in patients with large/giant coronary artery aneurysms following Kawasaki disease. We aimed to evaluate the safety and efficacy of apixaban in this high-risk pediatric population and compare it to conventional anticoagulant therapy. METHODS: In this retrospective study, we described our experience with the use of apixaban in patients with Kawasaki disease with large/giant coronary artery aneurysms. In patients who were previously exposed to conventional anticoagulation, we compared rates of new coronary thrombosis or myocardial infarction (effectiveness) and clinically relevant bleeding (safety) during apixaban versus antecedent conventional therapy. All patients received concomitant antiplatelet agents. Apixaban dosing was guided by weight and anti-Xa chromogenic assays. RESULTS: Between 2018 and 2025, 28 patients with Kawasaki disease (median age 6.7 years; 75% male) with large/giant coronary artery aneurysms were prescribed apixaban. Of these, 27 (96%) had previously received vitamin K antagonists or low molecular weight heparin. The rates of new coronary thrombosis and new myocardial infarctions were not higher when patients received apixaban versus conventional anticoagulation (0.025 versus 0.041 events per person-year; incidence rate ratio [IRR], 0.61 [95% CI, 0.06-3.3] and 0.013 versus 0.041 events per person-year; IRR, 0.31 [95% CI, 0.01-2.5], respectively). Rates of clinically relevant bleeding were also not higher for apixaban versus conventional therapy (0.038 versus 0.058 events per person-year, IRR, 0.66 [95% CI, 0.11-2.5]). CONCLUSIONS: In this retrospective single-center series of pediatric patients with Kawasaki disease with large/giant coronary artery aneurysms, apixaban combined with antiplatelet therapy was well tolerated and demonstrated no evidence of increased harm relative to conventional anticoagulants. Multicenter research is needed to confirm these findings and define the optimal therapeutic range for apixaban in this high-risk population.
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Baker et al. (2026) conducted an observational in Kawasaki disease with large/giant coronary artery aneurysms (n=28). Apixaban plus antiplatelet therapy vs. Antecedent conventional anticoagulation (vitamin K antagonists or low molecular weight heparin) plus antiplatelet therapy was evaluated on New coronary thrombosis (IRR 0.61, 95% CI 0.06-3.3). Apixaban did not increase new coronary thrombosis or bleeding vs conventional anticoagulation.
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