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Scenario
You are looking after a previously well child recently diagnosed with Kawasaki disease (KD). You start him on intravenous immunoglobulin (IVIG) and are about to start him on aspirin. Knowing the potential adverse effects of aspirin, you wonder whether low-dose aspirin is as effective as high-dose aspirin to prevent coronary artery complications.
Structured clinical question
In a child with KD (patient), is low-dose aspirin (intervention) as effective as high-dose aspirin (control) in reducing the risk of coronary artery complications (outcome) when used with IVIG.
Search strategy and outcome
PubMed and Medline (Ovid, 1946-present) were searched in June 2017 using the following keywords: Kawasaki AND (aspirin OR salicyl* OR ASA) AND (dose OR dosage). Results were limited to those published in English. Case reports and small case series were excluded, as were studies in which patients were not treated with IVIG and those that did not compare different aspirin doses (including a low 'anti-thrombotic' dose) within the same study. This identified 333 articles, of which six were relevant ( table 1 ). A hand search of these publications (and those listed in table 2 ) revealed no additional articles.
| Citation | Study group | Study type | Outcomes | Key results | Comments |
| Dallaire et al 1 (2017) | Canada 1213 children with KD (2004-2015) | Retrospective cohort | Prevalence of CAA (z score>=2.5), duration of fever | All treated with IVIG (single dose 2g/kg)Paracetamol use not reportedHigh-dose ASA (80mg/kg/day) (n=848) vs low-dose ASA (3-5mg/kg/day) (n=365) New CAA: 20.5% vs 22.2%, adjusted risk difference: 0.3% (95% CI -4.5% to 5.0%) Persistent CAA (>6weeks): 13.2% vs 12.3%, adjusted risk difference: -1.9% (-5.3% to 1.5%) Duration of fever: 7.8+-3.8days vs 7.9+-2.6days, adjusted risk difference: 0.18 days (-0.2 to 0.61 days) Follow-up: 12months | Study concludes no difference in reduction of risk of CAA between high-dose and low-dose ASA Large study Aspirin dose based on centre guidelines and not severity of disease Variation in rescue therapy (second dose of IVIG, steroid and monoclonal antibody use, and so on) |
| Kim et al 2 (2017) | Korea 8456 children with KD | Retrospective cohort | Prevalence of CAA (z score>=2.5and Japanese criteria) | All treated with IVIG (single dose 2g/kg)Paracetamol use not reportedMedium/high-dose ASA (>=30mg/kg/day) (n=7947) vs low-dose ASA (3-5mg/kg/day) n=509z-score: 24.8% vs 18.3% (p=0.001) Japanese... |