Secondary prevention

In the case of Kawasaki disease (KD), long-term management and secondary prevention overlap. In 2019, the American Heart Association (AHA) made general recommendations for cardiovascular risk reduction in high-risk pediatric patients, including those with KD.[80] However, the authors of this topic suggest following the more detailed long-term management recommendations from the 2017 and 2024 AHA guidelines.[1][28]​​

  • Promote healthy lifestyle and activity at every visit.

  • Use an alternative antiplatelet agent such as clopidogrel if long-term treatment with aspirin is indicated but the patient cannot tolerate, or is resistant to, aspirin.

  • Restrict physical contact sports in patients on anticoagulation or dual antiplatelet therapy. Participation in competitive sports or high-intensity activities should be guided by results from testing for inducible myocardial ischaemia or exercise-induced arrhythmias.

  • Assess cardiovascular risk factors including blood pressure, fasting lipid profile, body mass index, waist circumference, diet, activity, and smoking at time intervals appropriate to the disease severity.

  • Include history and physical exam, echocardiography, and electrocardiography in follow-up cardiology assessment at time intervals appropriate to the disease severity.

  • Include stress echocardiography, stress with magnetic resonance imaging (MRI), stress nuclear medicine, or positron emission tomography in additional cardiology assessment to detect inducible myocardial ischaemia at time intervals appropriate to the disease severity.

  • Include angiography by computed tomography, MRI, or invasive angiography if further imaging is needed at time intervals appropriate to the disease severity.

  • Reproductive counselling is important for patients with a history of KD, but evidence to guide recommendations is limited.[1]​[79]​ Based on clinical experience in practice, patients with significant cardiac sequelae who are taking systemic anticoagulants or dual antiplatelet therapy should avoid oestrogen-containing oral contraceptives when possible due to the increased risk of thrombosis. In patients with residual coronary abnormalities, pregnancy should be supervised by a multidisciplinary team including a cardiologist who is familiar with management of patients with KD. It may be necessary to alter thromboprophylaxis during pregnancy and delivery.[1]​

Use of this content is subject to our disclaimer