Multicenter and Retrospective Case Study of Warfarin and Aspirin Combination Therapy in Patients With Giant Coronary Aneurysms Caused by Kawasaki Disease

• Published in: Circulation Journal Vol. 73; no. 7; pp. 1319 - 1323
• Main Authors: Suda, Kenji, Kudo, Yoshiyuki, Higaki, Takashi, Nomura, Yuichi, Miura, Masaru, Matsumura, Masahiko, Ayusawa, Mamoru, Ogawa, Shunichi, Matsuishi, Toyojiro
• Format: Journal Article
• Language: English
• Published: Japan The Japanese Circulation Society 01.07.2009
• Subjects: Administration, Oral; Adolescent; Anticoagulants; Anticoagulants - therapeutic use; Antiplatelets; Aspirin - therapeutic use; Child; Child, Preschool; Coronary Aneurysm - diagnosis; Coronary Aneurysm - drug therapy; Coronary Aneurysm - etiology; Coronary artery disease; Coronary Thrombosis - epidemiology; Drug Therapy, Combination; Female; Follow-Up Studies; Humans; Infant; Kawasaki disease; Male; Mucocutaneous Lymph Node Syndrome - complications; Prognosis; Retrospective Studies; Risk Factors; Treatment Outcome; Warfarin - therapeutic use
• ISSN: 1346-9843; 1347-4820
• DOI: 10.1253/circj.CJ-08-0931

Background: To determine the prognosis of patients with giant coronary aneurysms (GA) caused by Kawasaki disease (KD) treated with combined oral warfarin and aspirin. Methods and Results: A multicenter follow-up study of 83 patients (65 males, 18 females) with GA who had been treated for ≥3 months with warfarin. Most patients were placed on the combination therapy as soon as the GA was detected and remained on it for 6.0 ±5.3 years, giving a total of 482 patient-years. Target international normalized ratio of prothrombin time ranged from 1.5 to ≥2.5. During this observational period, 5 patients suffered from 8 episodes of acute myocardial infarction and 1 died. Coronary thrombus formation enforced 6 courses of intracoronary thrombolysis in 3 patients (1-4 times). Consequently, freedom of cardiac events was 92.5% at 1 year and 91% at 10 years and the linearized cardiac event rate was 2.9% patient-year. Hemorrhagic complications occurred on 8 occasions (1 subdural hematoma) in 5 patients, giving 1.7% patient-year. Conclusions: The combination of warfarin and aspirin has an acceptably high cardiac-event-free survival in patients with GA caused by KD, though it has a certain risk of hemorrhagic complications. (Circ J 2009; 73: 1319-1323)