Document Detail

Long-term anticoagulation in Kawasaki disease: Initial use of low molecular weight heparin is a viable option for patients with severe coronary artery abnormalities.
MedLine Citation:
PMID:  20431996     Owner:  NLM     Status:  MEDLINE    
Patients with severe coronary artery involvement after Kawasaki disease (KD) require long-term systemic anticoagulation. We sought to compare our experience with thrombotic coronary artery occlusions, safety profile, and degree of coronary artery aneurysm regression in KD patients treated with low molecular weight heparin (LMWH) versus warfarin. Medical records of all KD patients diagnosed between January 1990 and April 2007 were reviewed. Of 1374 KD patients, 38 (3%) received systemic anticoagulation, 25 patients received LMWH from diagnosis onward, 12 of whom were subsequently switched to warfarin, and 13 received warfarin from onset. The frequency of thrombotic coronary artery occlusions was similar between drugs. Severe bleeding was more frequent in patients on warfarin, but minor bleeding was more frequent for patients on LMWH. Patients on warfarin were at greater risk of underanticoagulation or overanticoagulation (defined as achieving an anti-activated factor X level or an international normalized ratio below or above target level) than patients on LMWH (P < 0.05). Maximum coronary artery aneurysm z-scores diminished with time for patients on LMWH (P = 0.03) but not for those on warfarin (P = 0.55). This study suggests that LMWH is a potentially viable alternative for patients, especially young ones, with severe coronary artery involvement after KD.
Cedric Manlhiot; Leonardo R Brandão; Zeeshanefatema Somji; Amy L Chesney; Catherine MacDonald; Rebecca C Gurofsky; Tarun Sabharwal; Nita Chahal; Brian W McCrindle
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Publication Detail:
Type:  Comparative Study; Journal Article; Research Support, Non-U.S. Gov't     Date:  2010-04-30
Journal Detail:
Title:  Pediatric cardiology     Volume:  31     ISSN:  1432-1971     ISO Abbreviation:  Pediatr Cardiol     Publication Date:  2010 Aug 
Date Detail:
Created Date:  2010-07-27     Completed Date:  2010-11-09     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  8003849     Medline TA:  Pediatr Cardiol     Country:  United States    
Other Details:
Languages:  eng     Pagination:  834-42     Citation Subset:  IM    
Division of Cardiology, Department of Pediatrics, University of Toronto, Labatt Family Heart Centre, The Hospital for Sick Children, 555 University Avenue, Toronto, ON M5G 1X8, Canada.
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MeSH Terms
Anticoagulants / administration & dosage,  therapeutic use*
Child, Preschool
Coronary Disease / complications*,  drug therapy,  ultrasonography
Dose-Response Relationship, Drug
Follow-Up Studies
Heparin, Low-Molecular-Weight / administration & dosage,  therapeutic use*
Mucocutaneous Lymph Node Syndrome / complications,  drug therapy*,  ultrasonography
Retrospective Studies
Severity of Illness Index
Time Factors
Treatment Outcome
Warfarin / administration & dosage,  therapeutic use
Reg. No./Substance:
0/Anticoagulants; 0/Heparin, Low-Molecular-Weight; 81-81-2/Warfarin

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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