title: National Japanese survey of thrombolytic therapy selection for coronary aneurysm: intracoronary thrombolysis or intravenous coronary thrombolysis in patients with Kawasaki disease.
abstract: BACKGROUND
  Thrombolytic therapy for coronary aneurysm thrombosis of Kawasaki disease (KD) includes antiplatelet and anticoagulants, i.v. coronary thrombolysis (IVCT), and i.c. thrombolysis (ICT). Therapeutic methods, drugs and doses vary among medical facilities.
  
  
  RESULTS
  A nationwide survey of thrombolytic therapy was conducted under the auspices of the Ministry of Health, Labour and Welfare Research Program to Intractable Diseases Research Grants. A secondary survey targeted 14 facilities conducting thrombolytic therapy during a 5 year period (2004-2009). The primary survey investigated performance of thrombolytic therapy for 23 KD patients at 14 facilities, and of these, five with acute myocardial infarction had received ICT and combined therapy. The secondary survey investigated the pre-treatment condition of aneurysm and thrombosis and actual treatment methods. ICT was effective for small thrombi (≤ 10 mm), while IVCT was effective even for giant thrombi (>10 mm). ICT was also effective for thrombi within several hours after formation.
  
  
  CONCLUSIONS
  In the present nationwide survey, thrombolytic therapy was more effective in cases of a shorter duration between thrombus formation and the start of treatment. It was found that many facilities used only IVCT for thrombus alone. Medications given to KD children did not cause serious hemorrhagic complications, unlike in adults. Although doses exceeded recommended levels in many cases, the only complications were nasal bleeding and fever.
authors.affiliation: Department of Pediatrics, Juntendo University Faculty of Medicine, Tokyo, Japan.
authors.forename: Mana
authors.initials: M
authors.lastname: Harada
authors.forename: Katsumi
authors.initials: K
authors.lastname: Akimoto
authors.forename: Shunichi
authors.initials: S
authors.lastname: Ogawa
authors.forename: Hitoshi
authors.initials: H
authors.lastname: Kato
authors.forename: Yosikazu
authors.initials: Y
authors.lastname: Nakamura
authors.forename: Kenji
authors.initials: K
authors.lastname: Hamaoka
authors.forename: Tsutomu
authors.initials: T
authors.lastname: Saji
authors.forename: Toshiaki
authors.initials: T
authors.lastname: Shimizu
authors.forename: Tatsuo
authors.initials: T
authors.lastname: Kato
mesh_terms: D000293:Adolescent; D000328:Adult; D002648:Child; D002675:Child, Preschool; D003323:Coronary Aneurysm / Q000150:complications*; D003328:Coronary Thrombosis / Q000188:drug therapy* / Q000209:etiology*; D003331:Coronary Vessels; D005260:Female; D019538:Health Care Surveys; D006801:Humans; D007223:Infant; D007275:Injections, Intravenous; D007564:Japan; D008297:Male; D009080:Mucocutaneous Lymph Node Syndrome / Q000150:complications*; D018579:Patient Selection; D012189:Retrospective Studies; D015912:Thrombolytic Therapy / Q000379:methods*; D055815:Young Adult
keywords: Kawasaki disease; acute myocardial infarction; coronary aneurysm; coronary thrombolysis; i.c. thrombolysis