Published in:
01-03-2021 | Aneurysm | Original Article
Comparison Between Currently Recommended Long-Term Medical Management of Coronary Artery Aneurysms After Kawasaki Disease and Actual Reported Management in the Last Two Decades
Authors:
Jonathon Osborne, Kevin Friedman, Kyle Runeckles, Nadine F. Choueiter, Therese M. Giglia, Frederic Dallaire, Jane W. Newburger, Tisiana Low, Mathew Mathew, Andrew S. Mackie, Nagib Dahdah, Anji T. Yetman, Ashraf S. Harahsheh, Geetha Raghuveer, Kambiz Norozi, Jane C. Burns, Supriya Jain, Tapas Mondal, Michael A. Portman, Jacqueline R. Szmuszkovicz, Andrew Crean, Brian W. McCrindle, for the International Kawasaki Disease Registry
Published in:
Pediatric Cardiology
|
Issue 3/2021
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Abstract
In the 2017 American Heart Association (AHA) Kawasaki disease (KD) guidelines, risk levels (RLs) for long-term management are defined by both maximal and current coronary artery (CA) dimensions normalized as z-scores. We sought to determine the degree to which current recommended practice differs from past actual practice, highlighting areas for knowledge translation efforts. The International KD Registry (IKDR) included 1651 patients with CA aneurysms (z-score > 2.5) from 1999 to 2016. Patients were classified by AHA RL using maximum CA z-score (RL 3 = small, RL 4 = medium, RL 5 = large/giant) and subcategorized based on decreases over time. Medical management provided was compared to recommendations. Low-dose acetylsalicylic acid (ASA) use ranged from 86 (RL 3.1) to 95% (RL 5.1) for RLs where use was “indicated.” Dual antiplatelet therapy (ASA + clopidogrel) use ranged from 16% for RL 5.2 to 9% for RL 5.4. Recommended anticoagulation (warfarin or low molecular weight heparin) use was 65% for RL 5.1, while 12% were on triple therapy (anticoagulation + dual antiplatelet). Optional statin use ranged from 2 to 8% depending on RL. Optional beta-blocker use was 2–25% for RL 5, and 0–5% for RLs 3 and 4 where it is not recommended. Generally, past practice was consistent with the latest AHA guidelines, taking into account the flexible wording of recommendations based on the limited evidence, as well as unmeasured patient-specific factors. In addition to strengthening the overall evidence base, knowledge translation efforts may be needed to address variation in thromboprophylaxis management.