A 10-year-old boy is diagnosed with Kawasaki disease (KD) presenting with 6 days of fever and 4 of the 5 classic criteria. Echocardiography on day 7 shows a right coronary artery Z-score of +3.2. The initial treatment combining IVIG and aspirin is given. The PRIMARY reason for giving high-dose aspirin in the acute phase of KD is:
- A Prevention of coronary artery aneurysm formation
- B Anti-inflammatory and antipyretic effect via COX-1/COX-2 inhibition ✓
- C Antiplatelet effect to prevent thrombosis in dilated coronary arteries
- D Synergistic effect with IVIG to reduce B-cell mediated vasculitis
Explanation
In the acute febrile phase of Kawasaki disease, high-dose aspirin (80–100 mg/kg/day in 4 divided doses) is used for its anti-inflammatory and antipyretic effects. Once the patient is afebrile for 48–72 hours, aspirin is stepped down to low-dose (3–5 mg/kg/day) for its antiplatelet effect to prevent thrombosis in any coronary artery aneurysms that may have formed. The evidence that high-dose aspirin specifically prevents coronary artery aneurysms (as opposed to IVIG) is weak — IVIG (2 g/kg as single dose) is the primary therapy shown to reduce aneurysm risk when given within days 5–10. Low-dose aspirin is continued at least until 6–8 weeks or until coronary arteries normalize.
Reference: Ghai Essential Pediatrics, 10th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.