| Objective:To explore the efficacy and safety of warfarin combination of aspirin in the treatment of Kawasaki disease with giant coronary artery aneurysm(GCAA),and to provide clinical reference for the long-term management of KD children with GCAA and improve their prognosis.Methods:Cases of children diagnosed with Kawasaki disease combined with giant coronary artery aneurysm who were hospitalized at the First Affiliated Hospital of Guangxi Medical University from December 2002 to December2019 were collected.The general data,symptoms and signs,hematological examination results,echocardiography,transcatheter coronary angiography and other results of the included cases were collected;the coronary artery diameter retraction,hemorrhagic complications and major adverse cardiovascular events(coronary stenosis,coronary obstruction,myocardial infarction,thrombotic events,etc.),therapeutic medication and dose were followed up.During the follow-up period,the children were treated with oral warfarin and low-dose aspirin,with aspirin at 3-5 mg/(kg-d)once/d and warfarin at 0.05-0.12 mg/(kg-d)once/d,while maintaining the international standardized ratio of 1.5-2.5.During the treatment,the children were closely observed for bleeding manifestations and adjusted according to their condition.The dose of warfarin should be adjusted according to the patient’s condition.The children were divided into groups according to different conditions: according to the course of treatment using warfarin combined with low-dose aspirin,the children were divided into:treatment ≤ 2 years group,2-6 years group,> 6 years group;according to whether hormone therapy was used in the acute phase,the children were divided into: combined hormone therapy group,no hormone therapy group.Descriptive statistics were performed on the general data of the study subjects.The measurement data were expressed as mean ± standard deviation(x ± s).The comparison of the mean of measurement data was performed by t test or analysis of variance;the enumeration data were expressed as the number of cases and percentage.The comparison was performed by χ2 test or Fisher’s exact test.P<0.05 was considered statistically significant.The clinical data of the included patients were retrospectively analyzed to summarize the efficacy and safety of the studied treatment regimens.Results:(1)Of the 44 children,36(81.8%)were males and 8(18.2%)were females,with an mean age of onset of 4.82 years(range,0.32 years to 13.33years).There were 13 children(29.5%)in the ≤ 2-year course group,18children(41%)in the 2-to 6-year course group,and 13 children(29.5%)in the > 6-year course group.In the acute phase,8 children(18.2%)were treated with hormones and 36 children(81.8%)were not treated with hormones.(2)The distribution of GCAA in the coronary arteries of children in different treatment groups and hormone treatment groups was consistent.26 branches of the left coronary artery trunk,18 branches of the right coronary artery,9 branches of the left anterior descending branch and 7 branches of the left circumflex branch were involved in GCAA,and the number of cases in which both sides were involved was 16.(3)Transcatheter coronary angiography was performed in 8 of the 44 children.Seven of the children were male and one was female.The age of transcatheter coronary angiography was 5.4 years(1.3-12.25 years).A total of13 coronary arteries were involved in 8 children.The left coronary artery trunk was 8(61.5%)and the right coronary artery was 5(38.5%).Six of the children underwent echocardiography and cardiac CT at the same time as transcatheter coronary angiography.8 of the children who underwent transcatheter coronary angiography had an absolute maximum internal diameter of 11.86 mm(8-18mm)of the involved coronary arteries.Coronary thrombosis was observed in six cases(75%),coronary occlusion in one case(12.5%),myocardial infarction in one case(12.5%),and death in one case(12.5%).One child had ventricular fibrillation during coronary angiography,and the rhythm returned to sinus after electric defibrillation was given,and left coronary angiography was not performed.One child with coronary occlusion had electrocardiogram suggesting anterior interstitial and posterior wall myocardial infarction,and myocardial infarction by Both catheter coronary angiography and cardiac CT suggested occlusion of the distal left coronary artery trunk,and transcatheter coronary angiography showed the formation of coronary collateral circulation.(4)There were 7 cases(53.8%)of coronary regression in the ≤2-year course group,15 cases(83.3%)in the 2-to 6-year course group,and 9 cases(69.2%)in the >6-year course group.The difference between the groups was not statistically significant(P = 0.221).There were 7(87.5%)and 23(63.9%)cases of coronary regression in the acute combined cortisol hormone treatment group and the group without combined glucocorticoid treatment,respectively,and the difference between the groups was not statistically significant(P = 0.194).(5)The number of cases of intracoronary thrombosis was 8(61.5%),9(50%),and 2(15.4%)in the ≤ 2 years course group and the 2 ～ 6 years course > 6 years course group,respectively,and the difference was statistically significant(P = 0.046).The number of myocardial infarction cases in the three treatment course groups was 6(46.1%),1(5.6%)and 1(7.7%),respectively,and the difference was statistically significant(P = 0.014).There was no significant difference in the incidence of death,coronary artery stenosis and coronary artery occlusion between different treatment course groups(P = 0.165).There were 2cases(25%)of death,2 cases(25%)of stenosis and 0 case of occlusion in the combined hormone therapy group without hormone therapy,and the difference in the incidence rate was statistically significant(P = 0.03).There was no statistically significant difference in the incidence of intracoronary thrombosis and myocardial infarction between the groups(P values were 0.229 and 0.623,respectively).(6)Among bleeding events,there were no significant differences between different course of treatment groups and hormone therapy groups(P-values were0.81 and 0.566,respectively).(7)There was a significant difference in the absolute values of coronary artery diameter at the start and end points of follow-up in 44 children.Conclusion:1.The most commonly involved coronary arteries in children with Kawasaki disease combined with giant coronary aneurysms are the left main coronary artery,followed by the right coronary artery,bilateral coronary arteries,and less frequently the left anterior descending and left circumflex branches.2.Kawasaki disease complicated by a giant coronary aneurysm has a large inner diameter of the involved coronary artery and retraction may require a longer treatment period.3.Long-term warfarin with aspirin anticoagulation reduces the risk of coronary thrombosis and myocardial infarction.4.The effect of cortisol hormone treatment in the acute phase of Kawasaki disease is unclear and requires a larger sample of case follow-up studies.5.The incidence of bleeding events did not increase with the course of anticoagulation therapy,and bleeding events could occur at all stages of anticoagulation therapy. |
PDF Full Text Request