A Meta-analysis On Effect Of Optimal Dose Of Aspirin Treatment In Acute Kawasaki Disease

BACKGROUNDKawasaki disease, mucocutaneous lymph node syndrome is a systemic vasculitis of unknown aetiology that has been reported worldwide since its initial description in Japanese children. The most significant sequelae of acute Kawasaki disease are related to the inflammation of small to medium sized arteries and, in particular, coronary artery dilatation and the development of coronary artery aneurysms.Because the aetiology is unknown, pharmacological therapy is nonspecific and directed towards modulation of the inflammatory response and inhibition of platelet activation with the aim of preventing coronary artery aneurysms. Although aspirin remains an integral component of standard therapy for acute Kawasaki disease(KD) in the intravenous immunoglobulin(IVIG)era, the optimal dose remains controversial.OBJECTIVETo assess the effect of different doses of aspirin in treatment of Kawasaki disease (KD).METHODWe searched studies in the electronic databases including MEDLINE, EMBASE, Cochrane Library, CNKI, WANFANG, VIP Database from its establishment to December2013. All clinical controlled trials comparing which dose of aspirin in treatment of Kawasaki disease, from March1993to March2013,were eligible. Randomized clinical trials (RCT) on the early treatment of KD with inaspirin were included and assessed for clinical efficacy. Quality assessment was investigated according to the Kawasaki disease diagnosis, study design and blinding of outcome detection. Heterogeneity was evaluated by stratified analysis. Statistical analysis was performed by using State11.0software. Datas were combined for meta analysis using odds ratios (OR) for dichotomous data or weighted mean difference(WMD) for continuous data. Random effects statistical model or fixed effects model was used.RESULTS1583studies were identified from database search.53studies were selected for further assessment through reading the title and abstract.9eligible studies(3randomized controlled trials and6comparative studies)were enrolled in the meta-analysis according to the further assessment. Quality assessments results showed two studies were enrolled2, two studies were enrolled3, four studies were enrolled4, one study enrolled5, respectively. Meta-analysis showed the high dose of aspirin to the low dose of aspirin was associated with a significant risk reduction of the duration of fever (RR=-1.51,95%CI:-2.56—0.45).The incidence rate of coronary artery aneurysm was not significantly different between high dose of aspirin and low dose of aspirin (RR=0.6,95%CI:0.39-0.92).CONCLUSIONSMeta-analysis showed the high dose of aspirin was associated with a significant risk reduction of the duration of fever. The incidence rate of coronary artery aneurysm was not significantly different between high dose of aspirin and low dose of aspirin.It made no difference in the devepment of coronary artery aneurysm whether to have aspirin or not. Aspirin can cause liver damage, so the application of high dose aspirin should be more cautious.