Variation in Pharmacologic Management of Patients with Kawasaki Disease with Coronary Artery Aneurysms.
Document Type
Article
Publication Date
1-2022
Identifier
DOI: 10.1016/j.jpeds.2021.08.072
Abstract
OBJECTIVE: To evaluate practice variation in pharmacologic management in the International Kawasaki Disease Registry (IKDR).
STUDY DESIGN: Practice variation in intravenous immunoglobulin (IVIG) therapy, anti-inflammatory agents, statins, beta-blockers, antiplatelet therapy, and anticoagulation was described.
RESULTS: We included 1627 patients from 30 IKDR centers with maximum coronary artery aneurysm (CAA) z scores 2.5-4.99 in 848, 5.0-9.99 in 349, and ≥10.0 (large/giant) in 430 patients. All centers reported IVIG and acetylsalicylic acid (ASA) as primary therapy and use of additional IVIG or steroids as needed. In 23 out of 30 centers, (77%) infliximab was also used; 11 of these 23 centers reported using it in20% of patients. Nonsteroidal anti-inflammatory agents were used in >10% of patients in only nine centers. Beta-blocker (8.8%, all patients) and abciximab (3.6%, all patients) were mainly prescribed in patients with large/giant CAAs. Statins (2.7%, all patients) were mostly used in one center and only in patients with large/giant CAAs. ASA was the primary antiplatelet modality for 99% of patients, used in all centers. Clopidogrel (18%, all patients) was used in 24 centers, 11 of which used it in >50% of their patients with large/giant CAAs.
CONCLUSIONS: In the IKDR, IVIG and ASA therapy as primary therapy is universal with common use of a second dose of IVIG for persistent fever. There is practice variation among centers for adjunctive therapies and anticoagulation strategies, likely reflecting ongoing knowledge gaps. Randomized controlled trials nested in a high-quality collaborative registry may be an efficient strategy to reduce practice variation.
Journal Title
The Journal of pediatrics
Volume
240
First Page
164
Last Page
170
PubMed ID
34474088
Keywords
Kawasaki; management; variation
Recommended Citation
Selamet Tierney ES, Runeckles K, Tremoulet AH, et al. Variation in pharmacologic management of patients with Kawasaki disease with coronary artery aneurysms. The Journal of Pediatrics. 2022;240. doi:10.1016/j.jpeds.2021.08.072
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