Acute-phase Treatment and Prevention of Large Coronary Artery Lesions in Kawasaki Disease

Kawasaki disease (KD) is a type of febrile systemic vasculitis that mostly affects children under the age of five. CALs, or coronary artery lesions, are a serious consequence of KD. However, there is no recognised acute-phase therapy for the prevention of high CALs and coronary artery stenosis induced by KD. I’ve analysed the results of clinical trials undertaken in our department on acute-phase treatment and prevention of big CALs in KD in this book.

Intravenous immunoglobulin (IVIG) therapy at 2 g/kg, along with medium- or high-dose aspirin, is the current standard treatment for acute-phase KD. However, the effectiveness of combining medium- or high-dose aspirin with 2 g/kg IVIG therapy has not been thoroughly studied. According to certain research, aspirin may impede CAL prevention in IVIG therapy and that the delayed use of aspirin (DUA) for IVIG therapy may be useful for suppressing CALs and preventing coronary artery stenosis in KD patients. CAL problems are linked to a number of causes. Because single IVIG therapy has no effect on the clinical course of KD, doctors can better manage treatment progress and administer rescue medications for IVIG resistance and KD relapse at the right moment. With acute-phase care using risk classification before and after initial treatment, initial single IVIG therapy (2 g/kg/dose) with DUA, and appropriate rescue therapies employing IVIG and plasma exchange, the majority of KD patients had excellent medium-term outcomes. Furthermore, a single dosage of 2 g/kg IVIG therapy combined with DUA exhibited advantages in terms of preventing coronary artery stenosis, lowering KD recurrence rates, cost-effectiveness, and protection against severe infections.

Author(S) Details

Toshimasa Nakada
Department of Pediatrics, Aomori Prefectural Central Hospital, Higashi- tukurimiti 2-1-1, Aomori City, Aomori Prefecture, Japan.

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