The Clinical Research Of Anticoagulation On Kawasaki Disease With Coronary Aneurysms

Objective:To discuss the prognosis of wafarin Anticoagulation therapy,and long-term follow up with coronary aneurysms secondary to Kawasaki disease.Methods: A retrospective analysis about the patiens were diagnosed as KD with coronary artery aneurysm in the children’s Hospital of Medical University Of Chongqing,between Jan 2014 and Dec 2016.49 patiens were divided into small,medium and Giant coronary artery aneurysm group.and the Giant coronary artery aneurysm group were treated with warfarin plus aspirin,at the same time appling other antiplatelet drugs.The warfarin group was followed up an international normalized ratio(INR)of 1.5-2.5.Both of the 3 groups were followed up the Echocardiography and electrocardiogram.The data which include the changes of CAA and thrombus.Results:1.In the 49 cases of coronary artery aneurysm,The coronary artery aneurysms distributed the left main coronary artery(LM)(77.6%),right coronary artery branch(RCA)(73.5%)and left anterior descending coronary artery(LAD)(65.3%),less involvement of the left circumflex(LCX)(26.5%).2.The small CAA group have regressed(100%),medium coronary artery aneurysm group have regressed(88.9%).The rate of coronary aneurysm regression is 40% in GCA group.1 cases returned to normal,but the coronary artery dilatation was found in the patients 1 year later.4 cases of GCAA had no change;2 patiens of GCAA expand,and 1 cases was stenosis.Small and medium coronary aneurysms are more likely to shrink than GCAA.There was no cardiovascular event in the giant coronary aneurysm group.3.There are 3 cases of thrombosis in small CAA group(14.3%).and medium coronary artery aneurysm group have 9 patients(50%).In the group GCA,10 patiens had thrombosis(100%).There was a significant difference in thrombosis between the small and medium-sized coronary artery aneurysm and the giant coronary aneurysm group.The most common site of thrombosis occurred in the left anterior descending.In the 3 groups,Both in >4mm and 4≤r<5 of the diameter of CAA were 3 cases of thrombosis,the diameter over 5mm were 25 thrombosis.It warning that the diameter of CAA over 5mm may be a risk factor for thrombosis.4.11 cases of thrombosis were all disappeared(100%)in the small and medium CAA groups.In GCAA group,disppearing about 50 percent.Thrombosis was reduced in 4 cases(40%),1 cases(10%)was enlarged.During the period of follow-up,6 patients developed new thrombosis.From the comparison of the 3 groups of thrombosis,the thrombosis of GCAA is difficult to disappear.5.There were 4 patiens occurred epistaxis and ecchymosis after knocked,1 cases had severe hemorrhage.Conclusion:1.The GCAA is unfavourable prognosis,which may lead to enlargement of CAA,thrombosis,coronary artery stenosis and cardiac disfunction.2.The more greater of diameter of coronary artery aneurysm,the higher risk of thromboembolism.the diameter of CAA over 5mm may be a risk factor for thrombosis.3.For GCAA,Wafrin anticoagulation has no concluded to prognosis in prevention of cardiovascular events,but wafrin can increased bleeding risk,we need to be careful and to focus long-term follow-up the untoward effect of wafrin and echocardiography.