Kawasaki disease secondary prevention: Difference between revisions
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Created page with "__NOTOC__ {{Kawasaki disease}} {{CMG}}; {{AE}} ==Overview== There are no established measures for the secondary prevention of [disease name]. OR Effective measures for the..." |
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==Secondary Prevention== | ==Secondary Prevention== | ||
===AHA Scientific Statement on Kawasaki Disease=== | |||
====Recommendations for Prevention of Thrombosis During the Acute Illness==== | |||
The [[American Heart Association|AHA]] Recommendations for the prevention of Thrombosis during the acute illness are:<ref name="McCrindleRowley2017">{{cite journal|last1=McCrindle|first1=Brian W.|last2=Rowley|first2=Anne H.|last3=Newburger|first3=Jane W.|last4=Burns|first4=Jane C.|last5=Bolger|first5=Anne F.|last6=Gewitz|first6=Michael|last7=Baker|first7=Annette L.|last8=Jackson|first8=Mary Anne|last9=Takahashi|first9=Masato|last10=Shah|first10=Pinak B.|last11=Kobayashi|first11=Tohru|last12=Wu|first12=Mei-Hwan|last13=Saji|first13=Tsutomu T.|last14=Pahl|first14=Elfriede|title=Diagnosis, Treatment, and Long-Term Management of Kawasaki Disease: A Scientific Statement for Health Professionals From the American Heart Association|journal=Circulation|volume=135|issue=17|year=2017|pages=e927–e999|issn=0009-7322|doi=10.1161/CIR.0000000000000484}}</ref> | |||
{| class="wikitable" style="width:80%" | |||
|- | |||
| colspan="1" style="text-align:center; background:LightGreen" |[[ACC AHA guidelines classification scheme#Classification of Recommendations|Class I]] | |||
|- | |||
| bgcolor="LightGreen" |<nowiki>"</nowiki>'''1.''' Low-dose ASA (3–5 mg·kg−¹·d−¹) should be administered to patients without evidence of coronary artery changes until 4 to 6 weeks after onset of illness.''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])'' <nowiki>"</nowiki> | |||
|- | |||
| colspan="1" style="text-align:center; background:LemonChiffon" | [[ACC AHA guidelines classification scheme#Classification of Recommendations|Class IIa]] | |||
|- | |||
| bgcolor="LemonChiffon" |<nowiki>"</nowiki>'''1.''' For patients with rapidly expanding coronary artery aneurysms or a maximum Z score of ≥10, systemic anticoagulation with LMWH or warfarin (international normalized ratio target 2.0–3.0) in addition to low dose ASA is reasonable. ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: B]])'' <nowiki>"</nowiki> | |||
|- | |||
| colspan="1" style="text-align:center; background:LemonChiffon" | [[ACC AHA guidelines classification scheme#Classification of Recommendations|Class IIb]] | |||
|- | |||
| bgcolor="LemonChiffon" |<nowiki>"</nowiki>'''1.''' For patients at increased risk of thrombosis, for example, with large or giant aneurysms (≥8 mm or Z score ≥10) and a recent history of coronary artery thrombosis, “triple therapy” with ASA, a second antiplatelet agent, and anticoagulation with warfarin or LMWH may be considered. ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])'' <nowiki>"</nowiki> | |||
|- | |||
| colspan="1" style="text-align:center; background:LightCoral" | [[ACC AHA guidelines classification scheme#Classification of Recommendations|Class III]] | |||
|- | |||
| bgcolor="LightCoral" |<nowiki>"</nowiki>'''1.''' Ibuprofen and other non steroidal anti-inflammatory drugs with known or potential involvement of cyclooxygenase pathway may be harmful in patients taking ASA for its antiplatelet effects. ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: B]])'' <nowiki>"</nowiki> | |||
|} | |||
====Recommendations for Risk Stratification of Coronary Artery Abnormalities==== | |||
{| class="wikitable" style="width:80%" | |||
|- | |||
| colspan="1" style="text-align:center; background:LemonChiffon" | [[ACC AHA guidelines classification scheme#Classification of Recommendations|Class IIa]] | |||
|- | |||
| bgcolor="LemonChiffon" |<nowiki>"</nowiki>'''1.''' It is reasonable to use echocardiographic coronary artery luminal dimensions converted to BSA-adjusted Z scores to determine risk stratification. ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: B]])'' <nowiki>"</nowiki> | |||
|- | |||
| bgcolor="LemonChiffon" |<nowiki>"</nowiki>'''2.''' It is reasonable to incorporate both maximal and current coronary artery involvement in risk stratification. ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])'' <nowiki>"</nowiki> | |||
|- | |||
| bgcolor="LemonChiffon" |<nowiki>"</nowiki>'''3.''' It is reasonable to incorporate the presence of additional features other than coronary artery luminal dimensions into decisions regarding risk stratification. ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])'' <nowiki>"</nowiki> | |||
|} | |||
==References== | ==References== | ||
Revision as of 03:46, 28 April 2018
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Kawasaki disease Microchapters |
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American Roentgen Ray Society Images of Kawasaki disease secondary prevention |
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Risk calculators and risk factors for Kawasaki disease secondary prevention |
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief:
Overview
There are no established measures for the secondary prevention of [disease name].
OR
Effective measures for the secondary prevention of [disease name] include [strategy 1], [strategy 2], and [strategy 3].
Secondary Prevention
AHA Scientific Statement on Kawasaki Disease
Recommendations for Prevention of Thrombosis During the Acute Illness
The AHA Recommendations for the prevention of Thrombosis during the acute illness are:[1]
| Class I |
| "1. Low-dose ASA (3–5 mg·kg−¹·d−¹) should be administered to patients without evidence of coronary artery changes until 4 to 6 weeks after onset of illness.(Level of Evidence: C) " |
| Class IIa |
| "1. For patients with rapidly expanding coronary artery aneurysms or a maximum Z score of ≥10, systemic anticoagulation with LMWH or warfarin (international normalized ratio target 2.0–3.0) in addition to low dose ASA is reasonable. (Level of Evidence: B) " |
| Class IIb |
| "1. For patients at increased risk of thrombosis, for example, with large or giant aneurysms (≥8 mm or Z score ≥10) and a recent history of coronary artery thrombosis, “triple therapy” with ASA, a second antiplatelet agent, and anticoagulation with warfarin or LMWH may be considered. (Level of Evidence: C) " |
| Class III |
| "1. Ibuprofen and other non steroidal anti-inflammatory drugs with known or potential involvement of cyclooxygenase pathway may be harmful in patients taking ASA for its antiplatelet effects. (Level of Evidence: B) " |
Recommendations for Risk Stratification of Coronary Artery Abnormalities
| Class IIa |
| "1. It is reasonable to use echocardiographic coronary artery luminal dimensions converted to BSA-adjusted Z scores to determine risk stratification. (Level of Evidence: B) " |
| "2. It is reasonable to incorporate both maximal and current coronary artery involvement in risk stratification. (Level of Evidence: C) " |
| "3. It is reasonable to incorporate the presence of additional features other than coronary artery luminal dimensions into decisions regarding risk stratification. (Level of Evidence: C) " |
References
- ↑ McCrindle, Brian W.; Rowley, Anne H.; Newburger, Jane W.; Burns, Jane C.; Bolger, Anne F.; Gewitz, Michael; Baker, Annette L.; Jackson, Mary Anne; Takahashi, Masato; Shah, Pinak B.; Kobayashi, Tohru; Wu, Mei-Hwan; Saji, Tsutomu T.; Pahl, Elfriede (2017). "Diagnosis, Treatment, and Long-Term Management of Kawasaki Disease: A Scientific Statement for Health Professionals From the American Heart Association". Circulation. 135 (17): e927–e999. doi:10.1161/CIR.0000000000000484. ISSN 0009-7322.