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Comparison Between Currently Recommended Long-Term Medical Management of Coronary Artery Aneurysms After Kawasaki Disease and Actual Reported Management in the Last Two Decades
- Source :
- Pediatric Cardiology. 42:676-684
- Publication Year :
- 2021
- Publisher :
- Springer Science and Business Media LLC, 2021.
-
Abstract
- In the 2017 American Heart Association (AHA) Kawasaki disease (KD) guidelines, risk levels (RLs) for long-term management are defined by both maximal and current coronary artery (CA) dimensions normalized as z-scores. We sought to determine the degree to which current recommended practice differs from past actual practice, highlighting areas for knowledge translation efforts. The International KD Registry (IKDR) included 1651 patients with CA aneurysms (z-score > 2.5) from 1999 to 2016. Patients were classified by AHA RL using maximum CA z-score (RL 3 = small, RL 4 = medium, RL 5 = large/giant) and subcategorized based on decreases over time. Medical management provided was compared to recommendations. Low-dose acetylsalicylic acid (ASA) use ranged from 86 (RL 3.1) to 95% (RL 5.1) for RLs where use was “indicated.” Dual antiplatelet therapy (ASA + clopidogrel) use ranged from 16% for RL 5.2 to 9% for RL 5.4. Recommended anticoagulation (warfarin or low molecular weight heparin) use was 65% for RL 5.1, while 12% were on triple therapy (anticoagulation + dual antiplatelet). Optional statin use ranged from 2 to 8% depending on RL. Optional beta-blocker use was 2–25% for RL 5, and 0–5% for RLs 3 and 4 where it is not recommended. Generally, past practice was consistent with the latest AHA guidelines, taking into account the flexible wording of recommendations based on the limited evidence, as well as unmeasured patient-specific factors. In addition to strengthening the overall evidence base, knowledge translation efforts may be needed to address variation in thromboprophylaxis management.
- Subjects :
- medicine.medical_specialty
medicine.drug_class
business.industry
Warfarin
Low molecular weight heparin
Guideline
030204 cardiovascular system & hematology
Vascular surgery
medicine.disease
Cardiac surgery
03 medical and health sciences
0302 clinical medicine
Aneurysm
medicine.anatomical_structure
030228 respiratory system
Internal medicine
Pediatrics, Perinatology and Child Health
medicine
Kawasaki disease
Cardiology and Cardiovascular Medicine
business
Artery
medicine.drug
Subjects
Details
- ISSN :
- 14321971 and 01720643
- Volume :
- 42
- Database :
- OpenAIRE
- Journal :
- Pediatric Cardiology
- Accession number :
- edsair.doi...........05ddfd789baa463a6da18c42146f12eb