Pilot Study on the New Design of low Molecular-Weight Heparin Combination Therapy for Kawasaki Disease

Abstract

Background: The prognosis of patients with Kawasaki disease has been improved by the use of gamma-globulin. However, cases that are resistant to gamma-globulin have been difficult to manage. In this pilot study, we hypothesized that the combined use of dalteparin and gamma-globulin would reduce the prevalence of coronary artery lesions and prevent resistance to gamma-globulin therapy in Kawasaki disease. Methods: This was a retrospective study of 126 patients with Kawasaki disease who were admitted to our hospital. The data of the incidence of nationwide surveys of Kawasaki disease in 2005 and 2006 were used as the control group. The patients were treated with dalteparin + (gamma-globulin +aspirin) or dalteparin + aspirin alone. The survey of coronary artery lesion by echocardiography was followed-up three months after discharge. Results: The prevalence of gamma-globulin-resistant cases for our hospital vs. the nationwide survey was 8.2% vs. 16.2%, respectively (p < 0.001). The prevalence of cardiovascular damage (acute period) was 4.8% vs. 12.9%, respectively (p < 0.02). The prevalence of cardiovascular sequelae was 0.0% vs. 3.8% (p < 0.03). Conclusions: Compared with the nationwide survey, it is possible that dalteparin significantly reduces the prevalence of resistant cases and cardiovascular damage and sequelae. However, randomized controlled trials are needed to determine whether this approach should be widely adopted.