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Table 5 Anticoagulant drugs used in Kawasaki disease

From: Kawasaki disease: guidelines of Italian Society of Pediatrics, part II - treatment of resistant forms and cardiovascular complications, follow-up, lifestyle and prevention of cardiovascular risks

  Warfarin Non-fractionated heparin Low molecular weight heparin (LMWH)
Mechanism of action Block of synthesis of vitamin K-dependent coagulation factors (II, VII, IX and X) Bond with AT-III and inhibition of II, VII, IX, X, XI, XII coagulation factors Bond with AT-III and inhibition of II, VII, IX, X, XI, XII coagulation factors
Therapeutic indications Medium to giant aneurysms, history of heart attack, history of intra-aneurysm thrombosis Aneurysms with high thrombotic risk, before starting therapy with warfarin Same as non-fractioned heparin
Dosage Initial dose of 0.05–0.12 mg/kg/day, progressively increased over 4–5 days to obtain an INR between 2.0 and 2.5 Initial intravenous dose: 50 U/kg in 10 min or more, followed by 20–25 U/kg/hour to maintain aPTT between 60 and 85″  
Side effects Bleeding (epistaxis, gum bleeding, intracranial and intra-abdominal hemorrhage), embryopathies (dysostosis, dyschondroplasia, microcephaly) Hemorrhage, thrombocytopenia, hepatic dysfunction, rash, diarrhea, hair loss, osteoporosis Same as non-fractionated heparin, but less osteoporosis
Interactions Reduced efficacy with chlorophyll contained in green and yellow vegetables (with high contents of vitamin K), vitamin K-enriched milk, phenobarbital, carbamazepine, rifampicin; increased efficacy if breastfeeding, use of erythromycin, fluconazole, corticosteroids, amiodarone None None