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Meta-Analysis
. 2024 Nov 15;24(1):738.
doi: 10.1186/s12887-024-05202-2.

Different antithrombotic strategies to prevent cardiovascular complications in Kawasaki patients: a systematic review and meta-analysis

Ramin Assempoor  1 , Alireza Sattari Abroy  1 , Alireza Azarboo  1 , Amirhossein Ghaseminejad-Raeini  2 , Kimia Najafi  3 , Kaveh Hosseini  4   5
Affiliations
Meta-Analysis

Different antithrombotic strategies to prevent cardiovascular complications in Kawasaki patients: a systematic review and meta-analysis

Ramin Assempoor et al. BMC Pediatr. .

Abstract

Background: Coronary artery aneurysm (CAA) poses significant cardiovascular risks, particularly in Kawasaki disease (KD) patients. This systematic review and meta-analysis aim to evaluate and compare antithrombotic strategies in preventing CAA formation secondary to Kawasaki disease and the ensuing CAA cardiovascular complications.

Methods: Following PRISMA guidelines, we systematically searched major databases, namely PubMed, Scopus, Web of Science, and Embase. Major adverse cardiovascular events (MACE), myocardial infarction (MI), stenosis, bleeding, occlusion, and coronary artery lesion (CAL) formation were primary outcomes. Consolidated Standards of Reporting Trials (CONSORT) and Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) scores assessed study quality. A meta-analysis, as well as sensitivity analysis and meta-regression, was performed to compare the efficacy of pharmacological strategies on the outcomes.

Results: The study included 21 studies with 1045 patients for CAA complications and 41536 patients for CAA formation prevention. In children with CAA secondary to Kawasaki disease, the addition of warfarin to aspirin was associated with a significantly lower odds of myocardial infarction (OR = 0.26, 95% CI: 0.11-0.60, I2 = 25%) and mortality (OR = 0.18, 95% CI: 0.04-0.88, I2 = 0%) compared to aspirin alone. However, there was no significant difference in MACE (OR = 0.38, 95% CI: 0.08-1.93, I2 = 60%) and occlusion (OR = 0.17, 95% CI: 0.02-1.92, I2 = 58%). Sensitivity analysis showed reduced thrombosis (OR = 0.29, 95% CI: 0.14-0.62, I2 = 0%), MACE (OR [95% CI] = 0.22[0.06-0.84], I2 = 46%), and occlusion (OR [95% CI] = 0.08[0.02-0.44], I2 = 36%). Meta-regression did not yield significant results.

Conclusions: As for the acute phase of KD, no benefit was conferred from adding high-dose aspirin to the routine IVIG alone regimen. However, the complexity of outcomes and the diversity in antithrombotic interventions underscore the need for tailored approaches and further research.

Keywords: Cardiovascular Complications; Kawasaki disease; Meta-analysis; Prevention; Systematic Review.

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Conflict of interest statement

Declarations Competing interests The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
PRISMA flowchart of the study selection process
Fig. 2
Fig. 2
A Forest plot of the incidence of MACE in aspirin + warfarin vs. aspirin; B Forest plot of the incidence of myocardial infarction (MI) in aspirin + warfarin vs. aspirin; C Forest plot of the incidence of death/mortality in aspirin + warfarin vs. aspirin
Fig. 3
Fig. 3
A Forest plot of the incidence of occlusion in aspirin + warfarin vs. aspirin; B Forest plot of the incidence of stenosis in aspirin + warfarin vs. aspirin; C Forest plot of the incidence of thrombosis in aspirin + warfarin vs. aspirin
Fig. 4
Fig. 4
A Forest plot of the incidence of aneurysm regression in aspirin + warfarin vs. aspirin; B Forest plot of the incidence of CAL formation in IVIG vs. IVIG + aspirin; C Forest plot of the incidence of resistance to IVIG in IVIG vs. IVIG + aspirin
Fig. 5
Fig. 5
A Sensitivity analysis of the incidence of MACE in aspirin + warfarin vs. aspirin; B Sensitivity analysis of the incidence of occlusion in aspirin + warfarin vs. aspirin; C Sensitivity analysis of the incidence of thrombosis in aspirin + warfarin vs. aspirin
Fig. 6
Fig. 6
Funnel plot of the incidence of MACE meta-analysis
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