A 4-year-old child diagnosed with Kawasaki disease completes IVIG and high-dose aspirin. At 2-week follow-up, echocardiography shows a new 4.5 mm aneurysm in the right coronary artery. CRP has normalized. Which of the following is the recommended antiplatelet therapy for this child?

• A Warfarin with INR target 2.0-3.0
• B High-dose aspirin alone
• C Low-dose aspirin plus clopidogrel
• D Low-dose aspirin alone ✓

Explanation

For Kawasaki disease with small to medium coronary artery aneurysms (internal diameter <5 mm or z-score <10), low-dose aspirin alone is recommended for antiplatelet therapy. Giant aneurysms (z-score >10 or internal diameter >8 mm) require dual antiplatelet therapy or anticoagulation. D 4.5 mm aneurysm in a 4-year-old may be classified as small to medium; the recommended therapy is low-dose aspirin alone.

Reference: Nelson Textbook of Pediatrics, 21st ed.

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