Absence of hypercoagulability in acute Kawasaki disease.
BACKGROUND
Kawasaki disease (KD) is a systemic vasculitis syndrome with the striking feature of cardiovascular involvement. Endothelial cell (EC) damage has been suggested to predispose individuals to the development of coronary vascular disorders. When EC are perturbed, prethrombotic complications ensue. The purpose of this study was to examine the clinical relevance of EC activation and hypercoagulability in the pathogenesis of KD and to determine if plasma levels of these markers are correlated with the development of coronary aneurysms.


METHODS
EC function and coagulation status were assessed in 52 patients with acute KD, 20 febrile control subjects, and 20 healthy control subjects. Biological markers of EC and hypercoagulability were measured and included thrombomodulin, tissue factor, tissue factor pathway inhibitor, von Willebrand factor (vWF), coagulation factor VII (FVII), activated factor VII, prothrombin fragment 1 + 2 (F1 + 2), and D-dimer.


RESULTS
Transient dilatation of coronary arteries was the most common complication (55.8%), and coronary aneurysm was noted in five patients (9.6%). Levels of vWF, FVII, F1 + 2 and D-dimer were higher in acute KD patients compared with healthy controls but not febrile controls. Markers of EC and hypercoagulability were not different between patients with cardiac complications and those without cardiac complications. Biological and immunological assays did not demonstrate the prethrombotic state in acute KD.


CONCLUSIONS
Our results suggest that hypercoagulability does not occur during the acute stage of KD. Markers of EC damage and hypercoagulability are not predictive of coronary aneurysms in KD.
Lin
Ming-Tsan
MT
Department of Pediatrics, Changhua Christian Hospital, Changhua 500, Taiwan. mtsy@ms18.hinet.net
Tsao
Lon-Yen
LY
Cheng
Ming-Lin
ML
Chang
Yu-Jun
YJ
Chiu
Han-Yao
HY
Chen
Hsiao-Neng
HN
Kuo
Su-Feng
SF
Chiou
Shwu-Jin
SJ
D000208:Acute Disease; D002675:Child, Preschool; D042783:Endothelial Cells / Q000502:physiology; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D009080:Mucocutaneous Lymph Node Syndrome / Q000503:physiopathology*; D019851:Thrombophilia