206 - ANTICOAGULATION USE AFTER KD DIAGNOSIS

Background

Kawasaki Disease (KD) is an acute febrile illness that primarily affects young children. Despite being first described over five decades ago, KD continues to pose significant challenges in terms of early diagnosis, understanding its etiology, and optimizing treatment strategies. We look to determine how and which anticoagulants are used with additional attention to changes over time.

Methods:

We reviewed our electronic medical record (EMR) for new diagnoses of KD, an admission with a new diagnosis of KD and receiving intravenous immunoglobulin (IVIg) in the same hospitalization, between 1/1/2013 and 12/31/2022. We obtained demographic data, medications administered, and follow up information from the EMR. Medication use and timing of prescribing was obtained. We evaluated the use of anticoagulant and anti-platelet medications for up to 3 years after diagnosis.  We defined coronary artery dilation/aneurysms using echocardiogram Z-scores. Chi-square and ANOVA comparisons of groups determined changes in anticoagulation.

Results:

During the study period, 1094 children were admitted with a new KD diagnosis and had at least one follow up visit.  The average age was 3 years with males representing 62% of cases. Of these, all were discharged on aspirin, 850 (78%) remained on aspirin at initial follow up (between 1 and 6 weeks, average 3 weeks 2 days). Additional agents were needed in 52 (5%) patients including 12 (1%) on plavix for platelet count over one million or aspirin non-response, 42 (4%) on enoxaparin due to severe coronary dilation or large or giant aneurysms, with rare use of warfarin in the early post KD time period. 

By 8 weeks after admission, aspirin was stopped in 91% of patients. Of those started on additional anti-platelet medication, 7 (58%) were able to stop as platelet count dropped below one-million.  For patients requiring additional anticoagulation, only 4 (10%) were able to be taken of enoxaparin or warfarin within the first year and most 24 (57%) remained on additional anticoagulation at 3 years after diagnosis.  Timing of transition from enoxaparin to warfarin depended on patient age with the average age of transition 4.6 years at initiation of warfarin. 

Conclusions:

Standardization of anti-platelet and anti-coagulant treatment after KD as well as education regarding dosing and duration is needed. The majority of patients needing additional anticoagulation early in the diagnosis will require continued treatment.  Given the longer duration of treatment needs in this population additional alternatives to warfarin are needed.