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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