Association between aspirin dose and outcomes in patients with acute Kawasaki disease

BackgroundThe most effective dosage of aspirin to prevent coronary artery abnormalities in patients with acute Kawasaki disease remains unknown. Using a Japanese national inpatient database, this study aimed to identify the appropriate dose of aspirin to be prescribed to patients with acute Kawasaki disease. MethodWe used the Diagnostic Procedure Combination database to identify patients with Kawasaki disease treated with intravenous immunoglobulin between 2010 and 2021.The outcomes included the occurrence of coronary artery abnormalities and intravenous immunoglobulin resistance, length of stay, and medical costs. Restricted cubic spline functions were performed to examine the association between aspirin dose and the outcomes. ResultsData of 82109 patients were extracted from the database. Non-linear associations were observed between aspirin dose and the outcomes. In comparison with an aspirin dose of 30 mg/kg/day, the odds ratio (95% confidence interval) for coronary artery abnormalities was 1.40 (1.13-1.75) at 5 mg/kg/day. An aspirin dose of [≥]30 mg/kg/day did not significantly change the odds ratio for coronary artery abnormalities. Compared with a dose of 30 mg/kg/day, the odds ratio (95% confidence interval) for intravenous immunoglobulin resistance was 0.87 (0.76-1.00) at 5 mg/kg/day and 0.59 (0.36-0.98) at 80 mg/kg/day. An increase in aspirin dose was associated with a shorter length of stay and lower medical costs. ConclusionsLow-dose aspirin may increase the risk of coronary artery abnormalities in patients with acute Kawasaki disease; however, increasing aspirin doses beyond the standard doses may not be associated with a reduction in coronary artery abnormalities. High-dose aspirin showed the potential to reduce hospital stay and medical costs without increasing complications. Article SummaryThe study showed by restricted cubic spline that the dose of aspirin was no significant association between aspirin escalation and CAAs in patients with acute KD. Whats Known on This SubjectAspirin is standard treatments used with IVIG of acute Kawasaki Disease (KD), Few studies have shown the most effective dosage of aspirin to to prevent CAAs. What This Study AddsThe dose of aspirin was no significant association between aspirin escalation and CAAs in patients with acute KD.