Thrombo-inflammation and Rethinking the Role of Aspirin in Kawasaki Disease

PURPOSE OF REVIEW: Kawasaki Disease (KD) is a medium vessel vasculitis of young children that affects coronary arteries (CAs). The aim of therapy is to control inflammation and prevent coronary artery damage and alleviate thrombosis. This review aims to summarize the thrombosis-related complications and complementary therapy approaches to combat them. It also focuses on the ambiguity regarding the optimal aspirin dose in standard KD therapy. RECENT FINDINGS: KD patients with large or giant coronary artery aneurysms (CAAs) in particular face the risk of developing thrombosis. The standard therapy regimen during the acute phase consists of intravenous immunoglobulin (IVIG) plus aspirin. Although the dosing for IVIG is constant, the aspirin dose continues to be debated. The standard treatment with aspirin and IVIG might be adequate for individuals with small aneurysms whereas, patients suffering from large aneurysms and in a hypercoagulable state might need additional and extended therapy consisting of several antiplatelet reagents and anticoagulants. In case of thrombosis formation, thrombolytic therapy is also recommended. Cardiac and thrombotic problems are severe outcomes of KD. Patients need to be screened on a regular basis with echocardiography. The ideal aspirin dose during acute KD treatment is still controversial and while several recent studies pinpoint the superiority of low doses, there is no universal consensus. The variation in treatment response might be due to the different ethnic composition of study groups and inter-individual differences. Overall, close monitoring of patient response and finding the optimal treatment strategy is crucial.