Circulation Journal
Online ISSN : 1347-4820
Print ISSN : 1346-9843
ISSN-L : 1346-9843
Pediatric Cardiology and Adult Congenital Heart Disease
Multicenter and Retrospective Case Study of Warfarin and Aspirin Combination Therapy in Patients With Giant Coronary Aneurysms Caused by Kawasaki Disease
Kenji SudaYoshiyuki KudoTakashi HigakiYuichi NomuraMasaru MiuraMasahiko MatsumuraMamoru AyusawaShunichi OgawaToyojiro Matsuishi
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2009 Volume 73 Issue 7 Pages 1319-1323

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Abstract

Background: To determine the prognosis of patients with giant coronary aneurysms (GA) caused by Kawasaki disease (KD) treated with combined oral warfarin and aspirin. Methods and Results: A multicenter follow-up study of 83 patients (65 males, 18 females) with GA who had been treated for ≥3 months with warfarin. Most patients were placed on the combination therapy as soon as the GA was detected and remained on it for 6.0 ±5.3 years, giving a total of 482 patient-years. Target international normalized ratio of prothrombin time ranged from 1.5 to ≥2.5. During this observational period, 5 patients suffered from 8 episodes of acute myocardial infarction and 1 died. Coronary thrombus formation enforced 6 courses of intracoronary thrombolysis in 3 patients (1-4 times). Consequently, freedom of cardiac events was 92.5% at 1 year and 91% at 10 years and the linearized cardiac event rate was 2.9% patient-year. Hemorrhagic complications occurred on 8 occasions (1 subdural hematoma) in 5 patients, giving 1.7% patient-year. Conclusions: The combination of warfarin and aspirin has an acceptably high cardiac-event-free survival in patients with GA caused by KD, though it has a certain risk of hemorrhagic complications. (Circ J 2009; 73: 1319-1323)

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© 2009 THE JAPANESE CIRCULATION SOCIETY
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