Paredes Nethnapha, Mondal Tapas, Brandão Leonardo R, Chan Anthony K C
Thrombosis & Atherosclerosis Research Institute (TaARI), Hamilton General Hospital Campus, McMaster University, Hamilton, Ontario, Canada.
Blood Coagul Fibrinolysis. 2010 Oct;21(7):620-31. doi: 10.1097/MBC.0b013e32833d6ec2.
Kawasaki disease is an acute, systemic vasculitis of unknown cause affecting mainly neonates (infants) and young children. Despite treatment during the acute phase with intravenous immunoglobulin and aspirin, up to 5% of those affected will develop coronary aneurysms, predisposing them to thrombotic complications that could result in myocardial infarction and/or death. There are treatment protocols in place for the management of myocardial infarction in adults, but the practical nature of medication is unclear in children. To date, there are no clinical trials or specific recommendations on the dosing of thrombolytic therapy for the treatment of myocardial infarction in Kawasaki pediatric patients. However, there are reports of the use of thrombolytic agents, including streptokinase, urokinase and tissue plasminogen activator, as well as the monoclonal platelet glycoprotein (GP)IIb/IIIa receptor inhibitor, abciximab, that have been used to treat myocardial infarction in children with Kawasaki disease. The outcomes in these reports are varied. This review provides a summary of the available data on the management of children with Kawasaki disease suffering from myocardial infarction or thrombotic complications that can potentially lead to myocardial infarction.
川崎病是一种病因不明的急性全身性血管炎，主要影响新生儿（婴儿）和幼儿。尽管在急性期采用静脉注射免疫球蛋白和阿司匹林进行治疗，但仍有高达5%的患者会发生冠状动脉瘤，使他们易患血栓形成并发症，进而可能导致心肌梗死和/或死亡。目前有针对成人心肌梗死的治疗方案，但儿童用药的实际情况尚不清楚。迄今为止，尚无关于川崎病患儿心肌梗死溶栓治疗剂量的临床试验或具体建议。然而，有报道称使用了包括链激酶、尿激酶和组织纤溶酶原激活剂在内的溶栓药物，以及单克隆血小板糖蛋白（GP）IIb/IIIa受体抑制剂阿昔单抗，用于治疗川崎病患儿的心肌梗死。这些报道中的结果各不相同。本综述总结了有关川崎病患儿发生心肌梗死或可能导致心肌梗死的血栓形成并发症的现有管理数据。
