Potential alternatives in treatment of kawasaki disease to reduce the extremely rare risk of reye syndrome.

Background/objective: Kawasaki disease is an acute, systemic vasculitis most commonly observed in young Asian children. While the exact pathogenesis remains unknown, it is thought to be triggered by a pathogenic exposure that elicits an inflammatory response several days to 2 weeks before the onset of symptoms. Symptoms include edematous hands and feet, conjunctivitis, mucositis, a diffuse erythematous rash, lymphadenopathy, and a fever lasting for at least 5 days, which is required for diagnosis. In addition, coronary vessels may exhibit aneurysms, thrombosis, and stenosis. Without treatment, Kawasaki disease carries a 25% risk of developing coronary aneurysms. However, with the timely administration of intravenous immunoglobulin, this risk is reduced to 4%. Given the inflammation and possible thrombosis of the coronary vasculature, current guidelines recommend aspirin for the management of Kawasaki disease. Kawasaki disease is one of the few conditions in which administering aspirin to children is considered acceptable, despite the risk of inducing Reye syndrome, a potentially fatal condition triggered by a viral infection while taking salicylates such as aspirin. Therefore, this review addresses a key question: why continue to use aspirin with its known risk of Reye syndrome when alternative antithrombotic drugs used in pediatric patients are available? This review seeks to explore potential substitutes for aspirin to mitigate the risk of Reye syndrome while also providing the necessary anticoagulation in Kawasaki disease.