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Effectiveness of antiplatelet therapy for Kawasaki disease: a systematic review

  • Reo TanoshimaEmail author
  • Risa Hashimoto
  • Takanori Suzuki
  • Akira Ishiguro
  • Tohru Kobayashi
Original Article

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.

Keywords

Antiplatelet Kawasaki disease Pediatrics Systematic review 

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

Notes

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.

Authors’ 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.

Funding

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

Compliance with ethical standards

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.

Supplementary material

431_2019_3368_MOESM1_ESM.docx (18 kb)
ESM 1 (DOCX 18 kb)
431_2019_3368_MOESM2_ESM.xlsx (22 kb)
ESM 2 (XLSX 22 kb)

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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Department of PediatricsYokohama City UniversityYokohamaJapan
  2. 2.Center for Postgraduate Education and TrainingNational Center for Child Health and DevelopmentTokyoJapan
  3. 3.Division of CardiologyNational Center for Child Health and DevelopmentTokyoJapan
  4. 4.Department of Management and Strategy, Clinical Research CenterNational Center for Child Health and DevelopmentTokyoJapan

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