PDF(1434 KB)
Clinical effect and safety of clopidogrel combined with aspirin in antithrombotic therapy for children with Kawasaki disease complicated by small/medium-sized coronary artery aneurysms
LIU Yi-Ling, WANG Xian-Min, CHEN Ting-Ting, SHI Kun, LU Ya-Heng, GUO Yong-Hong, LI Yan
Chinese Journal of Contemporary Pediatrics ›› 2019, Vol. 21 ›› Issue (8) : 801-805.
PDF(1434 KB)
PDF(1434 KB)
Clinical effect and safety of clopidogrel combined with aspirin in antithrombotic therapy for children with Kawasaki disease complicated by small/medium-sized coronary artery aneurysms
Objective To study the clinical effect and safety of clopidogrel combined with aspirin in antithrombotic therapy for children with Kawasaki disease (KD) complicated by coronary artery aneurysm (CAA). Methods A total of 77 KD children who were diagnosed with multiple small/medium-sized CAAs by echocardiography between January 2013 and June 2018 were enrolled. They were randomly divided into observation group with 38 children (treated with clopidogrel and aspirin) and control group with 39 children (treated with low-molecular-weight heparin and aspirin). All children were followed up regularly, and the first 3 months of the course of the disease was the observation period. The children were observed in terms of the change of the coronary artery and the incidence of complications. Results At month 3 of follow-up, among the children in the observation group, 6 had normal coronary artery, 11 had coronary artery retraction, 19 had stable coronary artery, and 2 progressed to giant coronary aneurysm; among the children in the control group, 7 had normal coronary artery, 12 had coronary artery retraction, 19 had stable coronary artery, and 1 progressed to giant coronary aneurysm; there was no significant difference in the change of the coronary artery between the two groups (P > 0.05). There were 2 cases of epistaxis and 6 cases of skin ecchymosis in the observation group, and 1 case of epistaxis and 7 cases of petechiae and ecchymosis at the injection site in the control group, and no other serious bleeding events were observed in either group. Conclusions Clopidogrel combined with low-dose aspirin is safe and effective in antithrombotic therapy for children with KD complicated by CAA.
Kawasaki disease / Coronary artery aneurysm / Clopidogrel / Aspirin / Child
[1] Shuman ST, Rowley AH. Kawasaki disease:insights into pathogenesis and approaches to treatment[J]. Nat Rev Rheumatol, 2015, 11(8):475-482.
[2] Kim KY, Kim DS. Recent advances in Kawasaki disease[J]. Yonsei Med J, 2016, 57(1):15-21.
[3] Newburger JW, Takahashi M, Gerher MA, et al. Diagnosis, treatment, and long-term management of Kawasaki disease:a statement for health professionals from the Committee on Rheumatic Fever, Endocarditis, and Kawasaki Disease, Council on Cardiovascular Disease in the Young, American Heart Association[J]. Pediatrics, 2004, 114(6):1708-1733.
[4] 中华医学会儿科学分会心血管学组, 《中华儿科杂志》编辑委员会, 中华医学会儿科学分会免疫学组. 川崎病冠状动脉病变的临床处理建议[J]. 中华儿科杂志, 2012, 50(10):746-749.
[5] 刘芳, 赵璐, 吴琳, 等. 基于严重程度临床分级的川崎病冠状动脉病变的治疗和管理评价[J]. 中华儿科杂志, 2015, 53(9):690-695.
[6] Monagle P, Chan AKC, Goldenberg NA, et al. Antithrombotic therapy in neonates and children:Antithrombotic Therapy and Prevention of Thrombosis, 9th ed:American College of Chest Physicians Evidence-Based Clinical Practice Guidelines[J]. Chest, 2012, 141(2 Suppl):e737S-e801S.
[7] Authors/Task Force members, Windecker S, Kolh P, et al. 2014 ESC/EACTS Guidelines on myocardial revascularization:The Task on Myocardial Revascularization of the European Society of Cardiology (ESC) and the European Association for Cardio-Thoracic Surgery (EACTS) Developed with the special contribution of the European Association of Percutaneous Cardiovascular Interventions (EAPCI)[J]. Eur Heart J, 2014, 35(37):2541-2619.
[8] Japanese Circulation Society Joint Research Group. Guidelines for diagnosis and management of cardiovascular sequelae in Kawasaki disease[J]. Pediatr Int, 2005, 47(6):711-732.
[9] JCS Joint Working Group. Guidelines for diagnosis and management of cardiovascular sequelae in Kawasaki disease (JCS 2008)-digest version[J]. Circ J, 2010, 74(9):1989-2020.
[10] 杨敏, 钟家蓉, 张静, 等. 氯吡格雷联合阿司匹林治疗小儿川崎病抗血小板疗效及安全性分析[J]. 儿科药学杂志, 2014, 20(12):8-11.
[11] 梁秋月, 刘晓燕. 川崎病冠状动脉血栓形成发病机制及治疗进展[J]. 国际儿科学杂志, 2016, 43(3):213-215.
[12] 柳颐龄, 王献民, 李焰, 等. 内源性血管弹性蛋白酶在川崎病冠状动脉重构的作用研究[J]. 中国当代儿科杂志, 2014, 16(4):389-392.
[13] Yahata T, Suzuki C, Yoshioka A, et al. Platelet activation dynamics evaluated using platelet-derived microparticles in Kawasaki disease[J]. Circ J, 2014, 78(1):188-193.
[14] Sengupta D, Kahn AM, Bums JC, et al. Image-based modeling of hemodynamics in coronary artery aneurysms caused by Kawasaki disease[J]. Biomech Model Mechanobiol, 2012, 11(6):915-932.
[15] 刘芳, 黄国英. 川崎病血管合并症的处理与随访[J]. 中国实用儿科杂志, 2017, 32(8):579-583.
[16] Newburger JW, Takahashi M, Burns JC. Kawasaki disease[J]. J Am Coll Cardiol, 2016, 67(14):1738-1749.
[17] Manlhiot C, Brandao LR, Somji Z, et al. Long-term anticoagulation in Kawasaki disease:initial use of low molecular weight heparin is a viable option for patients with severe coronary artery abnormalities[J]. Pediatr Cardiol, 2010, 31(6):834-842.
[18] JCS Joint Working Group. Guidelines for diagnosis and treatment of patients with vasospastic angina (Coronary Spastic Angina) (JCS 2013)[J]. Circ J, 2014, 78(11):2779-2801.
[19] 朱晋坤, 毛华, 尹扬光, 等. 阿司匹林和氯吡格雷对体外血小板黏附内皮细胞基质活性的影响及其机制研究[J]. 中国全科医学, 2015, 18(3):283-287.
[20] 冯智, 黄清波. 双联抗血小板治疗小儿川崎病的近远期疗效及作用机制研究[J]. 新医学, 2018, 49(1):47-51.
[21] McCrindle BW, Rowley AH, Newburger JW, et al. Diagnosis, treatment, and long-term management of Kawasaki disease:a scientific statement for health professionals from the American Heart Association[J]. Circulation, 2017, 135(17):e927-e999.
