Department of Pediatrics, Yokohama City University, 3-9 Fukuura, Kanazawa-ku, Yokohama, Kanagawa, 236-0004, Japan.
Center for Postgraduate Education and Training, National Center for Child Health and Development, Tokyo, Japan.
Eur J Pediatr. 2019 Jun;178(6):947-955. doi: 10.1007/s00431-019-03368-x. Epub 2019 Mar 28.
Kawasaki disease is an acute systemic vasculitis in children. Antiplatelet medicines are commonly used for Kawasaki disease to attenuate vasculitis and prevent thromboembolism; however, the mechanisms have not been elucidated. The objective of this study is to assess the effectiveness of antiplatelet medications for Kawasaki disease. We used Medline, Embase, Cochrane Central Register of Controlled Trials, and Igaku Chuo Zasshi (Ichushi) from January 1947 to August 2018. Studies describing the platelet functions of antiplatelet drugs for Kawasaki disease were included. Twenty studies met the inclusion criteria. There were no randomized controlled trials. Seven studies compared platelet aggregation ability before and after treatment. Eight studies compared platelet aggregation with that in Kawasaki disease patients without treatment. Four studies compared aggregation among different types of antiplatelet drugs or at different doses. Antiplatelet medications administered in the studies included aspirin, flurbiprofen, dipyridamole, and choline salicylate. Methods for the measurement of platelet aggregation ability varied among studies. The groups with antiplatelet treatment tended to have a decreased platelet aggregation function. The statistical analyses were impossible due to insufficient quantitative data and heterogeneity among the studies.Conclusion: The present systematic review revealed that there was insufficient evidence for the effectiveness of antiplatelet therapy for Kawasaki disease. What is Known: • Antiplatelet therapy is widely used for Kawasaki disease to mitigate cardiac complications. • The mechanisms of antiplatelet therapy for Kawasaki disease are not clarified. What is New: • This systematic review showed that the groups with antiplatelet treatment tended to have a decreased platelet aggregation function. • There is insufficient evidence for the effectiveness of antiplatelet therapy for Kawasaki disease.
川崎病是一种儿童急性全身性血管炎。抗血小板药物常用于川崎病，以减轻血管炎症并预防血栓栓塞；然而，其机制尚未阐明。本研究旨在评估抗血小板药物治疗川崎病的疗效。我们检索了 1947 年 1 月至 2018 年 8 月期间的 Medline、Embase、Cochrane 对照试验中心注册库和 Igaku Chuo Zasshi（Ichushi）数据库。纳入描述抗血小板药物治疗川崎病时血小板功能的研究。符合纳入标准的有 20 项研究。但没有随机对照试验。7 项研究比较了治疗前后的血小板聚集能力。8 项研究比较了未经治疗的川崎病患者的血小板聚集情况。4 项研究比较了不同类型的抗血小板药物或不同剂量的聚集情况。研究中使用的抗血小板药物包括阿司匹林、氟比洛芬、双嘧达莫和胆碱水杨酸。测量血小板聚集能力的方法在不同的研究中有所不同。接受抗血小板治疗的组血小板聚集功能倾向于降低。由于研究之间缺乏定量数据和异质性，无法进行统计分析。结论：本系统评价显示，抗血小板治疗川崎病的疗效证据不足。已知情况：•抗血小板治疗广泛用于川崎病，以减轻心脏并发症。•抗血小板治疗川崎病的机制尚未阐明。新情况：•本系统评价表明，接受抗血小板治疗的组血小板聚集功能倾向于降低。•抗血小板治疗川崎病的疗效证据不足。
