title: High-dose aspirin for Kawasaki disease: outdated myth or effective aid?
abstract: OBJECTIVE
  To compare the efficacy and safety of intravenous immunoglobulin (IVIG) plus high-dose aspirin (HDA) vs. IVIG plus low-dose aspirin (LDA) for the treatment of Kawasaki disease, with an emphasis on coronary artery outcomes.
  
  
  METHODS
  This study was a retrospective, medical record review of paediatric patients with Kawasaki disease comparing 6 centres that routinely used HAD for initial treatment and 2 that used LDA in 2004-2013. Treatment response and adverse events were compared. The primary outcome measure was the occurrence of coronary aneurysm at the subacute or convalescent stage.
  
  
  RESULTS
  The cohort included 358 patients, of whom 315 were initially treated with adjunctive HDA and 43 with LDA. There were no demographic differences between the groups. Coronary aneurysms occurred in 10% (20/196) of the HDA group and 4% (1/24) of the LDA group (p=0.34). Equivalence tests indicate it is unlikely that the risk of coronary aneurysm in LDA exceeds HDA by more than 3.5%. There were no significant between-group differences in the need for glucocorticoid pulse therapy or disease recurrence. Coronary ectasia rate and hospitalisation time were significantly greater in the HDA group. Adverse events were similar in the two groups.
  
  
  CONCLUSIONS
  We found no significant clinical benefit in using IVIG+HDA in Kawasaki disease compared to IVIG+LDA. The use of adjunctive HDA in this setting should be reconsidered.
authors.affiliation: Department of Paediatrics, Schneider Children's Medical Center of Israel, Petach Tikva; and Sackler Faculty of Medicine, Tel Aviv University, Ramat Aviv, Israel.
authors.forename: Gil
authors.initials: G
authors.lastname: Amarilyo
authors.affiliation: Department of Paediatrics, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel.
authors.forename: Yael
authors.initials: Y
authors.lastname: Koren
authors.affiliation: Department of Paediatrics, Schneider Children's Medical Center of Israel, Petach Tikva, Israel.
authors.forename: Dafna
authors.initials: D
authors.lastname: Brik Simon
authors.affiliation: Department of Paediatrics, Shaare Zedek Medical Center, Jerusalem, Israel.
authors.forename: Maskit
authors.initials: M
authors.lastname: Bar-Meir
authors.affiliation: Sackler Faculty of Medicine, Tel Aviv University, Ramat Aviv; and Department of Paediatrics, Assaf Harofeh Medical Center, Zerifin, Israel.
authors.forename: Hilla
authors.initials: H
authors.lastname: Bahat
authors.affiliation: Department of Paediatrics, Rambam Medical Center, Haifa, Israel.
authors.forename: Mona Hanna
authors.initials: MH
authors.lastname: Helou
authors.affiliation: Department of Paediatrics, Meir Medical Center, Kfar Saba, Israel.
authors.forename: Amir
authors.initials: A
authors.lastname: Mendelson
authors.affiliation: Sackler Faculty of Medicine, Tel Aviv University, Ramat Aviv, Israel.
authors.forename: Nofar
authors.initials: N
authors.lastname: Hezkelo
authors.affiliation: Sackler Faculty of Medicine, Tel Aviv University, Ramat Aviv, Israel.
authors.forename: Gabriel
authors.initials: G
authors.lastname: Chodick
authors.affiliation: Department of Paediatrics, Hadassah Hebrew University Medical Center, Jerusalem, Israel.
authors.forename: Yackov
authors.initials: Y
authors.lastname: Berkun
authors.affiliation: Department of Paediatrics, Hadassah Hebrew University Medical Center, Jerusalem, Israel.
authors.forename: Eli
authors.initials: E
authors.lastname: Eisenstein
authors.affiliation: Department of Paediatrics, Rambam Medical Center, Haifa, Israel.
authors.forename: Yonatan
authors.initials: Y
authors.lastname: Butbul Aviel
authors.affiliation: Sackler Faculty of Medicine, Tel Aviv University, Ramat Aviv; and Department of Paediatrics, Sheba Medical Center, Tel Hashomer, Israel.
authors.forename: Galia
authors.initials: G
authors.lastname: Barkai
authors.affiliation: Sackler Faculty of Medicine, Tel Aviv University, Ramat Aviv; and Department of Paediatrics, Sheba Medical Center, Tel Hashomer, Israel.
authors.forename: Yoav
authors.initials: Y
authors.lastname: Bolkier
authors.affiliation: Sackler Faculty of Medicine, Tel Aviv University, Ramat Aviv; and Department of Paediatrics, Sheba Medical Center, Tel Hashomer, Israel.
authors.forename: Shai
authors.initials: S
authors.lastname: Padeh
authors.affiliation: Department of Paediatrics, Rambam Medical Center, Haifa, Israel.
authors.forename: Riva
authors.initials: R
authors.lastname: Brik
authors.affiliation: Department of Paediatrics, Shaare Zedek Medical Center, Jerusalem, Israel.
authors.forename: Phillip J
authors.initials: PJ
authors.lastname: Hashkes
authors.affiliation: Department of Paediatrics, Schneider Children's Medical Center of Israel, Petach Tikva; and Sackler Faculty of Medicine, Tel Aviv University, Ramat Aviv, Israel.
authors.forename: Liora
authors.initials: L
authors.lastname: Harel
authors.affiliation: Sackler Faculty of Medicine, Tel Aviv University, Ramat Aviv; and Department of Paediatrics, Meir Medical Center, Kfar Saba, Israel. uziely@zahav.net.il.
authors.forename: Yosef
authors.initials: Y
authors.lastname: Uziel
mesh_terms: D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000008:administration & dosage* / Q000009:adverse effects; D001241:Aspirin / Q000008:administration & dosage* / Q000009:adverse effects; D002648:Child; D002675:Child, Preschool; D003323:Coronary Aneurysm / Q000175:diagnosis / Q000276:immunology / Q000517:prevention & control*; D004359:Drug Therapy, Combination; D005260:Female; D006801:Humans; D016756:Immunoglobulins, Intravenous / Q000008:administration & dosage* / Q000009:adverse effects; D007155:Immunologic Factors / Q000008:administration & dosage* / Q000009:adverse effects; D007223:Infant; D007557:Israel; D008297:Male; D008499:Medical Records; D009080:Mucocutaneous Lymph Node Syndrome / Q000175:diagnosis / Q000188:drug therapy* / Q000276:immunology; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D000894:Anti-Inflammatory Agents, Non-Steroidal; D016756:Immunoglobulins, Intravenous; D007155:Immunologic Factors; D001241:Aspirin