For children with Kawasaki disease (KD), the use of low-dose aspirin, rather than high-dose aspirin, may not increase risk for recrudescent fever when given in combination with intravenous immunoglobulin (IVIG), according to study results published in JAMA Network Open.

The study was a retrospective cohort analysis that included 260 patients with KD who were treated at the Riley Hospital for Children in Indianapolis, Indiana, and who had a maximum age of 18 years at the first occurrence of KD. Evaluated patients received 2 g/kg IVIG and either low-dose aspirin (< 10 mg/kg/day) or high-dose aspirin (≥ 10 mg/kg/day). The primary study end point was fever recrudescence leading to KD retreatment within 2 weeks of initial treatment.

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Median patient age was 2.5 years (interquartile range, 1.6-4.3), and 54.6% of patients had received low-dose aspirin.

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Overall, 25.0% of the children in this study had experienced recrudescent fever, which affected 27.5% of patients on low-dose aspirin and 22.0% of patients on high-dose aspirin. The aspirin dosage regimen showed no relationship to the rate of fever recrudescence (odds ratio [OR], 1.34; 95% CI, 0.76-2.37; P =.31). The lack of association persisted in an analysis adjusted for age and disease severity (adjusted OR, 1.63; 95% CI, 0.89-2.97; P =.11).

Coronary artery abnormalities during this study occurred in 8.3% of patients overall, including 7.4% of patients on low-dose aspirin and 9.4% of patients on high-dose aspirin (P =.62). Hospital stays lasted a median of 3 days for each group (P =.27).

“Given the potential advantages, low-dose aspirin is an attractive option as initial therapy for KD,” stated the investigators.


1.     Platt B, Belarski E, Manaloor J, et al. Comparison of risk of recrudescent fever in children with Kawasaki disease treated with intravenous immunoglobulin and low-dose vs high-dose aspirin [published online January 3, 2020]. JAMA Netw Open. doi:10.1001/jamanetworkopen.2019.18565