Background: Coronary artery aneurysm (CAA) poses significant cardiovascular risks, particularly in Kawasaki disease (KD) patients. This systematic review and meta-analysis aim to evaluate and compare antithrombotic strategies in preventing CAA formation secondary to Kawasaki disease and the ensuing CAA cardiovascular complications.
Methods: Following PRISMA guidelines, we systematically searched major databases, namely PubMed, Scopus, Web of Science, and Embase. Major adverse cardiovascular events (MACE), myocardial infarction (MI), stenosis, bleeding, occlusion, and coronary artery lesion (CAL) formation were primary outcomes. Consolidated Standards of Reporting Trials (CONSORT) and Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) scores assessed study quality. A meta-analysis, as well as sensitivity analysis and meta-regression, was performed to compare the efficacy of pharmacological strategies on the outcomes.
Results: The study included 21 studies with 1045 patients for CAA complications and 41536 patients for CAA formation prevention. In children with CAA secondary to Kawasaki disease, the addition of warfarin to aspirin was associated with a significantly lower odds of myocardial infarction (OR = 0.26, 95% CI: 0.11-0.60, I = 25%) and mortality (OR = 0.18, 95% CI: 0.04-0.88, I = 0%) compared to aspirin alone. However, there was no significant difference in MACE (OR = 0.38, 95% CI: 0.08-1.93, I = 60%) and occlusion (OR = 0.17, 95% CI: 0.02-1.92, I = 58%). Sensitivity analysis showed reduced thrombosis (OR = 0.29, 95% CI: 0.14-0.62, I = 0%), MACE (OR [95% CI] = 0.22[0.06-0.84], I = 46%), and occlusion (OR [95% CI] = 0.08[0.02-0.44], I = 36%). Meta-regression did not yield significant results.
Conclusions: As for the acute phase of KD, no benefit was conferred from adding high-dose aspirin to the routine IVIG alone regimen. However, the complexity of outcomes and the diversity in antithrombotic interventions underscore the need for tailored approaches and further research.
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http://dx.doi.org/10.1186/s12887-024-05202-2 | DOI Listing |
Pediatr Rheumatol Online J
December 2024
Kawasaki Disease Center, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan.
Background: This study aims to develop Z-Score models to normalize measurements of three coronary arteries and enhance the diagnosis of Kawasaki disease (KD) in children from newborns to 10 years old. Developing a reliable Z-Score model is challenging, as some existing models fail the normality test. Overcoming these challenges is crucial for improving KD diagnosis.
View Article and Find Full Text PDFJ Card Fail
December 2024
Department of Cardiovascular Biology and Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan. Electronic address:
Background: To evaluate whether sodium zirconium cyclosilicate (SZC) enables the uptitration of spironolactone without increasing the risk of hyper- and hypokalemia in patients with heart failure with reduced and mildly reduced ejection fraction (HFrEF and HFmrEF) and moderate/severe chronic kidney disease (CKD) who developed hyperkalemia during treatment with suboptimal spironolactone dose.
Methods: The REGISTA-K is a randomized, double-blind, placebo-controlled, multicenter trial that examined the efficacy and safety of SZC in uptitrating spironolactone without the occurrence of hyperkalemia or hypokalemia. A total of 266 patients with HFrEF and HFmrEF and hyperkalemia will be randomized in a 1:1 ratio to receive either SZC or placebo after treating hyperkalemia with SZC at 25 sites in Japan.
Arch Virol
December 2024
Department of Medical Entomology, National Institute of Infectious Diseases, 1-23-1 Toyama, Shinjuku-ku, Tokyo, 162-8640, Japan.
Most members of the genus Orthonairovirus, represented by Crimean-Congo hemorrhagic fever virus and Nairobi sheep disease virus, are tick-borne, and some have become a public health concern in recent years. Here, we report the isolation and genetic and biological characterization of a new orthonairovirus, designated as "Iwanai Valley virus" (IWVV), from Ixodes ovatus ticks in Hokkaido, Japan. The amino acid sequence of the viral nucleoprotein (NP) was found to be 34-45% identical to those of known orthonairoviruses.
View Article and Find Full Text PDFJ Med Case Rep
December 2024
Department of Pediatrics, Faculty of Medicine, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran.
Cureus
November 2024
Department of Emergency Medicine, Gunma University Graduate School of Medicine, Maebashi, JPN.
Background: Out-of-hospital cardiac arrest (OHCA) has a poor prognosis. Patients with shockable rhythms often have better outcomes than those with nonshockable rhythms. A previous study reported a decline in shockable rhythms and poorer outcomes with the use of beta-blockers before OHCA.
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