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Effectiveness of antiplatelet therapy for Kawasaki disease: a systematic review

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Abstract

Kawasaki disease is an acute systemic vasculitis in children. Antiplatelet medicines are commonly used for Kawasaki disease to attenuate vasculitis and prevent thromboembolism; however, the mechanisms have not been elucidated. The objective of this study is to assess the effectiveness of antiplatelet medications for Kawasaki disease. We used Medline, Embase, Cochrane Central Register of Controlled Trials, and Igaku Chuo Zasshi (Ichushi) from January 1947 to August 2018. Studies describing the platelet functions of antiplatelet drugs for Kawasaki disease were included. Twenty studies met the inclusion criteria. There were no randomized controlled trials. Seven studies compared platelet aggregation ability before and after treatment. Eight studies compared platelet aggregation with that in Kawasaki disease patients without treatment. Four studies compared aggregation among different types of antiplatelet drugs or at different doses. Antiplatelet medications administered in the studies included aspirin, flurbiprofen, dipyridamole, and choline salicylate. Methods for the measurement of platelet aggregation ability varied among studies. The groups with antiplatelet treatment tended to have a decreased platelet aggregation function. The statistical analyses were impossible due to insufficient quantitative data and heterogeneity among the studies.

Conclusion: The present systematic review revealed that there was insufficient evidence for the effectiveness of antiplatelet therapy for Kawasaki disease.

What is Known:

• Antiplatelet therapy is widely used for Kawasaki disease to mitigate cardiac complications.

• The mechanisms of antiplatelet therapy for Kawasaki disease are not clarified.

What is New:

• This systematic review showed that the groups with antiplatelet treatment tended to have a decreased platelet aggregation function.

• There is insufficient evidence for the effectiveness of antiplatelet therapy for Kawasaki disease.

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Abbreviations

ADP:

Adenosine diphosphate

CONSORT:

Consolidated Standards of Reporting Trials

IVIG:

Intravenous immunoglobulin therapy

KD:

Kawasaki disease

PGF1:

Prostaglandin F1

PGE2:

Prostaglandin E2

PDMP:

Platelet-derived microparticles

PRISMA:

Preferred Reporting Items for Systematic Reviews and Meta-analyses

STROBE:

Strengthening the Reporting of Observational Studies in Epidemiology

TXB2:

Thromboxane B2

CAL:

Coronary artery lesion

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Acknowledgements

We thank Ms. Chiemi Kataoka and Ms. Yuko Serizawa, the information specialists at the National Center for Child Health and Development, Tokyo, Japan, and Dr. Reina Isayama, at the Department of Management and Strategy Clinical Research Center, the National Center for Child Health and Development, Tokyo, Japan, for their kind assistance with the literature search. We also appreciate Dr. Chemin Su at the Division of Clinical Research Planning, Clinical Research Center, National Center for Child Health and Development, Tokyo, Japan, for his kind support by reading the article written in Chinese.

Funding

This study was funded by the Japan Agency for Medical Research and Development (ek0109142h).

Author information

Authors and Affiliations

  1. Department of Pediatrics, Yokohama City University, 3-9 Fukuura, Kanazawa-ku, Yokohama, Kanagawa, 236-0004, Japan

    Reo Tanoshima

  2. Center for Postgraduate Education and Training, National Center for Child Health and Development, Tokyo, Japan

    Risa Hashimoto & Akira Ishiguro

  3. Division of Cardiology, National Center for Child Health and Development, Tokyo, Japan

    Takanori Suzuki

  4. Department of Management and Strategy, Clinical Research Center, National Center for Child Health and Development, Tokyo, Japan

    Tohru Kobayashi

Authors
  1. Reo Tanoshima
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  2. Risa Hashimoto
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  3. Takanori Suzuki
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  4. Akira Ishiguro
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  5. Tohru Kobayashi
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Contributions

AI and TK developed the concept of the study. RT, AI, and TK designed the study. RT, RH, and TS selected the eligible studies, collected the data, and summarized the data. RT wrote the initial draft of the manuscript. RH, TS, AI, and TK critically reviewed and revised the manuscript.

Corresponding author

Correspondence to Reo Tanoshima.

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Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

This study does not require ethical approval because this is a systematic review of published articles.

Informed consent

Informed consent is not necessary for this study because this is a systematic review of published articles.

Additional information

Communicated by Peter de Winter

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Tanoshima, R., Hashimoto, R., Suzuki, T. et al. Effectiveness of antiplatelet therapy for Kawasaki disease: a systematic review. Eur J Pediatr 178, 947–955 (2019). https://doi.org/10.1007/s00431-019-03368-x

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  • DOI: https://doi.org/10.1007/s00431-019-03368-x

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