Treatment algorithm

Please note that formulations/routes and doses may differ between drug names and brands, drug formularies, or locations. Treatment recommendations are specific to patient groups: see disclaimer

ACUTE

presentation ≤10 days from onset; or presentation >10 days from onset with evidence of ongoing inflammation

1st line – intravenous immunoglobulin (IVIG)

Back
ACUTE
|
presentation ≤10 days from onset; or presentation >10 days from onset with evidence of ongoing inflammation
1st line – 

intravenous immunoglobulin (IVIG)

The main goal of treatment is to prevent coronary artery disease and to relieve symptoms by controlling the inflammatory process. This is monitored by the defervescence and the resolution of all acute symptoms.

IVIG as a single infusion is the standard treatment and comprises the mainstay of therapy, and has been successful in reducing the duration of fever and the prevalence of coronary artery aneurysms in Kawasaki disease (KD).[32][51]​​

Treatment should be started as soon as a patient is diagnosed with either complete or incomplete KD.[1][13][28]​​ The best results are achieved when treatment is instituted within 10 days or even within 7 days.

It is also indicated in patients who present after 10 days with KD, even if fever has resolved.

Some patients may have persistent or recurrent fever 36-48 hours after a single dose of IVIG infusion. These patients are at increased risk of developing coronary artery abnormalities and may benefit from a second IVIG infusion, but guideline recommendations vary.

The 2021 American College of Rheumatology/Vasculitis Foundation recommends that patients with acute KD and persistent fever after initial treatment with IVIG should receive a second course of IVIG rather than advancing therapy with corticosteroids.[32]​ However, the 2024 American Heart Association guideline favours adding corticosteroids or a tumour necrosis factor (TNF)-alpha inhibitor for patients with IVIG-resistance over giving a second dose of IVIG.[28]​ European guidance recommends consideration of initiating corticosteroids along with the second dose of IVIG in this situation.[13]​ A second dose of IVIG should be given with caution in patients with blood type A, B, or AB given the high risk of haemolysis.[28]

Live immunisations, such as measles, mumps varicella, should be deferred for 11 months after IVIG administration due to the risk of suppressing the immune response to the vaccine.[51]​ For patients at high risk of exposure to measles, the immunisation can be given and repeated at least 11 months after IVIG exposure.​[13]

Primary options

normal immunoglobulin human: 2 g/kg intravenously as a single dose, may repeat dose 36-48 hours later if patient fails to defervesce

Plus – aspirin

Back
ACUTE
|
presentation ≤10 days from onset; or presentation >10 days from onset with evidence of ongoing inflammation
Plus – 

aspirin

Treatment recommended for ALL patients in selected patient group

Aspirin should be used with intravenous immunoglobulin (IVIG) therapy; it is thought to have an additive anti-inflammatory effect at higher doses, and can help prevent thrombosis via its antiplatelet effect at lower doses in Kawasaki disease (KD).[32]

The optimal dose of aspirin for acute KD is unclear and this remains an active area of research.[28][32]​ In the US, the anti-inflammatory dose used in this setting has historically been higher than the dose used in Japan and Europe. However, increasing evidence suggests that higher doses may not improve outcomes.[28][32]

The 2024 American Heart Association (AHA) guideline states that medium-dose aspirin during the acute phase is increasingly preferred in many centres.[28]​ The AHA recommends reducing the dose to antiplatelet dose levels 48-72 hours after fever resolves.[28]​ European guidelines also recommend medium-dose aspirin, but recommend reducing the dose 48 hours after fever resolves as long as clinical symptoms are improving and the CRP is falling.[13]

Low-dose aspirin should be continued for 6-8 weeks after the acute episode and can then be stopped if the echocardiogram remains normal.​[13][51]​​​ Patients with coronary artery aneurysms should be referred to cardiology. European guidelines note that patients with regressed aneurysms may have persistent endothelial function abnormalities and therefore ongoing low-dose aspirin should be considered depending on individual risk.[13]

Primary options

aspirin: medium-dose regimen: 30-50 mg/kg/day orally given in divided doses every 6 hours for 48-72 hours after fever resolves, followed by 3-5 mg/kg once daily for 6-8 weeks

More

Consider – corticosteroid or tumour necrosis factor (TNF)-alpha inhibitor

Back
ACUTE
|
presentation ≤10 days from onset; or presentation >10 days from onset with evidence of ongoing inflammation
Consider – 

corticosteroid or tumour necrosis factor (TNF)-alpha inhibitor

Additional treatment recommended for SOME patients in selected patient group

Adjunctive anti-inflammatory therapy (a corticosteroid or a TNF-alpha inhibitor) should be considered early as part of initial therapy alongside intravenous immunoglobulin (IVIG) for high-risk patients and patients with Kawasaki shock syndrome.[13][28]​​[32]

While the 2019 European guideline and 2021 American College of Rheumatology/Vasculitis Foundation (ACR/VF) guideline recommend corticosteroids as the preferred additional anti-inflammatory agent, the American Heart Association (AHA) recommends either a corticosteroid or a TNF-alpha inhibitor (e.g., infliximab, etanercept) as equal options.[13][28][32]

The 2024 AHA guideline recommends intensification of initial therapy with either a corticosteroid or a TNF-alpha inhibitor for patients with high-risk features, which they define as right coronary artery or left anterior descending Z score ≥2.5 at diagnosis, age <6 months, or patients in the high-risk category using the Son risk score (a risk score developed for prediction of coronary artery aneurysms in a North American population).[28]​ The AHA also recommends considering intensified initial therapy with IVIG plus a second anti-inflammatory agent for patients with Kawasaki shock syndrome.[28]

The 2021 ACR/VF guideline recommends that patients with acute Kawasaki disease (KD) who are at high risk of IVIG resistance or developing coronary artery aneurysms are given IVIG with an adjunctive corticosteroids as initial therapy rather than IVIG monotherapy, with high-risk defined as a Z score ≥2.5 for the left anterior descending coronary artery or right coronary artery at initial scan and aged <6 months, pending further studies to identify at risk patients in the US population.[32]​ They recommend that high-risk patients with acute KD are given IVIG with an adjunctive immunomodulatory/immunosuppressive agent as initial therapy rather than IVIG monotherapy, if corticosteroids are contraindicated.[32]

The 2019 European guidelines recommend that corticosteroids are given as first-line to those with severe disease (high CRP >100 mg/L, persistently elevated CRP despite treatment, anaemia, hypoalbuminaemia, liver dysfunction, haemophagocytic lymphohistiocytosis or shock), those with evolving coronary or peripheral aneurysms at presentation with evidence of ongoing inflammation, and patients aged <1 year.[13][50]​ 

In one meta-analysis, infliximab significantly reduced treatment resistance when used as initial treatment compared to IVIG alone.[73]​ One Cochrane review found low-certainty evidence that TNF-alpha inhibitors reduced treatment resistance and were associated with fewer infusion reactions compared with no treatment or additional IVIG. No differences were found in the incidence of coronary artery abnormalities or infections between groups.[72]

While meta-analyses support the use of corticosteroids in patients with high-risk KD, individual studies have produced conflicting results, and evidence comparing their efficacy with alternative anti-inflammatory therapies (e.g., TNF-alpha inhibitors) is limited.[58][59][60]​ One 2022 Cochrane review concluded that moderate-certainty evidence supports the use of corticosteroids in the acute phase of KD as it is associated with reduced coronary artery abnormalities, shorter duration of hospital stay, reduced inflammatory markers, and no serious adverse events or deaths when compared to those treated without corticosteroids.[59]​ Until more data are available, the subset of patients with KD with life-threatening complications should be given the option of corticosteroid therapy.[59][69]​​ [ Cochrane Clinical Answers logo ] The literature on the use of oral versus intravenous corticosteroid therapy in KD has produced conflicting results due to heterogeneity in the doses, regimens, and patient populations used in the studies.[61][62][63][64][65][66][67][68]

Primary options

methylprednisolone sodium succinate: 2 mg/kg/day intravenously given in divided doses every 12 hours for 5 days, then transition to oral prednisolone, maximum 60 mg/day

and

prednisolone: 2 mg/kg/day orally given in 2 divided doses starting after methylprednisolone course, continue until improvement then taper over 2-4 weeks, maximum 60 mg/day

OR

infliximab: 5-10 mg/kg intravenously as a single dose

OR

etanercept: 0.8 mg/kg subcutaneously once weekly for 3 doses, maximum 50 mg/dose

2nd line – corticosteroid or tumour necrosis factor (TNF)-alpha inhibitor

Back
ACUTE
|
presentation ≤10 days from onset; or presentation >10 days from onset with evidence of ongoing inflammation
2nd line – 

corticosteroid or tumour necrosis factor (TNF)-alpha inhibitor

Anti-inflammatory therapy (a corticosteroid or a TNF-alpha inhibitor) is recommended as second-line treatment for patients with intravenous immunoglobulin (IVIG) resistance or refractory disease.[13][28][32]

Various definitions for refractory Kawasaki disease (KD) have been postulated. The definition used in international guidelines and clinical trials is failure of resolution of fever within 36-48 hours of initial IVIG. However, it has been proposed that this definition should be broadened to include evidence of ongoing systemic inflammation within 48 hours of initial treatment; to detect children with ongoing inflammation who are at risk of developing or worsening cardiac sequelae.[50]​ IVIG resistance occurs in 10% to 20% of cases.[53]​ Patients with IVIG resistance are at a higher risk of developing coronary artery aneurysms.[13][54]

The 2024 American Heart Association guideline recommends either a corticosteroid or a TNF-alpha inhibitor (e.g., infliximab, etanercept) as equal options for patients with IVIG resistance.[28]

The 2019 European guidelines recommend a corticosteroid as the preferred option for patients with IVIG resistance (defined as either ongoing fever, persistent inflammation or ongoing clinical signs 48 hours after IVIG). A TNF-alpha inhibitor may be considered in patients with persistent inflammation despite IVIG, aspirin, and corticosteroids.[13]​ For patients with IVIG resistance, the guidelines suggest that corticosteroids may be used with or without a second dose of IVIG.[13]

In one meta-analysis, infliximab improved clinical course when used in IVIG-resistant patients compared to repeat IVIG.[73]​ One Cochrane review found low-certainty evidence that TNF-alpha inhibitors reduced treatment resistance and were associated with fewer infusion reactions compared with no treatment or additional IVIG. No differences were found in the incidence of coronary artery abnormalities or infections between groups.[72]

Meta-analyses suggest that corticosteroids are beneficial in refractory KD, and they appear to reduce the risk of heart problems after KD without causing any important side effects. However, individual studies have produced conflicting results, and evidence comparing their efficacy with alternative anti-inflammatory therapies (e.g., TNF-alpha inhibitors) is limited.[58][59][60]​ One 2022 Cochrane review concluded that moderate-certainty evidence supports the use of corticosteroids in the acute phase of KD as it is associated with reduced coronary artery abnormalities, shorter duration of hospital stay, reduced inflammatory markers, and no serious adverse events or deaths when compared to those treated without corticosteroids.[59]​ Until more data are available, the subset of patients with KD that are IVIG-resistant should be given the option of corticosteroid therapy.[59][69] [ Cochrane Clinical Answers logo ] ​ The literature on the use of oral versus intravenous corticosteroid therapy in KD has produced conflicting results due to heterogeneity in the doses, regimens, and patient populations used in the studies.[61][62][63][64][65][66][67][68]​​​

Primary options

methylprednisolone sodium succinate: 2 mg/kg/day intravenously given in divided doses every 12 hours for 5 days, then transition to oral prednisolone, maximum 60 mg/day

and

prednisolone: 2 mg/kg/day orally given in 2 divided doses starting after methylprednisolone course, continue until improvement then taper over 2-4 weeks, maximum 60 mg/day

OR

infliximab: 5-10 mg/kg intravenously as a single dose

OR

etanercept: 0.8 mg/kg subcutaneously once weekly for 3 doses, maximum 50 mg/dose

Plus – aspirin

Back
ACUTE
|
presentation ≤10 days from onset; or presentation >10 days from onset with evidence of ongoing inflammation
Plus – 

aspirin

Treatment recommended for ALL patients in selected patient group

Aspirin is thought to have an additive anti-inflammatory effect at higher doses, and can help prevent thrombosis via its antiplatelet effect at lower doses in Kawasaki disease (KD).[32] 

The optimal dose of aspirin for acute KD is unclear and this remains an active area of research.[28][32]​ In the US, the anti-inflammatory dose used in this setting has historically been higher than the dose used in Japan and Europe. However, increasing evidence suggests that higher doses may not improve outcomes.

The 2024 American Heart Association (AHA) guideline states that medium-dose aspirin during the acute phase is increasingly preferred in many centres.[28]​ The AHA recommends reducing the dose to antiplatelet dose levels 48-72 hours after fever resolves.[28]​ The European guidelines also recommend medium-dose aspirin, but recommend reducing the dose 48 hours after fever resolves as long as clinical symptoms are improving and the CRP is falling.[13]

Low-dose aspirin should be continued for 6-8 weeks after the acute episode and can then be stopped if the echocardiogram remains normal.​[13][51]​ Patients with coronary artery aneurysms should be referred to cardiology.​ European guidelines note that patients with regressed aneurysms may have persistent endothelial function abnormalities and therefore ongoing low-dose aspirin should be considered depending on individual risk.[13]

Primary options

aspirin: medium-dose regimen: 30-50 mg/kg/day orally given in divided doses every 6 hours for 48-72 hours after fever resolves, followed by 3-5 mg/kg once daily for 6-8 weeks

More

3rd line – other immunomodulatory drug or plasma exchange

Back
ACUTE
|
presentation ≤10 days from onset; or presentation >10 days from onset with evidence of ongoing inflammation
3rd line – 

other immunomodulatory drug or plasma exchange

There is no consensus or evidence as to whether ciclosporin, anakinra, or cyclophosphamide should be used after other treatments fail and cases should be discussed with a specialist centre.

One network meta-analysis found that the combination therapy with high-dose intravenous immunoglobulin (IVIG) and corticosteroids or ciclosporin may have an additional effect on improving the rate of decline of fever and lowering the incidence rate of coronary artery abnormalities in children with refractory Kawasaki disease (KD). However, the authors caution that new randomised trials would be required to support the results.[58]

Very rarely, plasma exchange may be considered for patients with refractory KD when all other treatment options are ineffective.[1][13] Evidence to support the use of plasma exchange for KD is limited, and this option should only be considered on a case-by-case basis in consultation with a KD specialist.[13]​ One retrospective study from Japan assessed the benefit of adding plasma exchange rescue (PER) to KD patients who were IVIG and infliximab non-responders. The study showed that the addition of PER improved fever, other acute symptoms, laboratory data, and coronary outcomes. These results remain uncertain pending future randomised trials.​[78]

Primary options

ciclosporin: 5 mg/kg/day orally given in 2 divided doses, adjust dose according to serum ciclosporin level, continue until clinical improvement then taper gradually according to response

Secondary options

anakinra: consult specialist for guidance on dose

OR

cyclophosphamide: consult specialist for guidance on dose

Plus – aspirin

Back
ACUTE
|
presentation ≤10 days from onset; or presentation >10 days from onset with evidence of ongoing inflammation
Plus – 

aspirin

Treatment recommended for ALL patients in selected patient group

Aspirin is thought to have an additive anti-inflammatory effect at higher doses, and can help prevent thrombosis via its antiplatelet effect at lower doses in Kawasaki disease (KD).[32] 

The optimal dose of aspirin for acute KD is unclear and this remains an active area of research.[32][28]​ In the US, the anti-inflammatory dose used in this setting has historically been higher than the dose used in Japan and Europe. However, increasing evidence suggests that higher doses may not improve outcomes.

The 2024 American Heart Association (AHA) guideline states that medium-dose aspirin during the acute phase is increasingly preferred in many centres.[28]​ The AHA recommends reducing the dose to antiplatelet levels 48-72 hours after fever resolves.[28]​ European guidelines also recommend medium-dose aspirin, but recommend reducing the dose 48 hours after fever resolves as long as clinical symptoms are improving and the CRP is falling.[13]

Low-dose aspirin should be continued for 6-8 weeks after the acute episode and can then be stopped if the echocardiogram remains normal.​[13][51]​ Patients with coronary artery aneurysms should be referred to cardiology.​ European guidelines note that patients with regressed aneurysms may have persistent endothelial function abnormalities and therefore ongoing low-dose aspirin should be considered depending on individual risk.[13]

Primary options

aspirin: medium-dose regimen: 30-50 mg/kg/day orally given in divided doses every 6 hours for 48-72 hours after fever resolves, followed by 3-5 mg/kg once daily for 6-8 weeks

More

presentation >10 days from onset without evidence of ongoing inflammation

1st line – low-dose aspirin

Back
ACUTE
|
presentation >10 days from onset without evidence of ongoing inflammation
1st line – 

low-dose aspirin

Patients with Kawasaki disease who present without persistent fever after day 10, and with normal acute-phase markers (erythrocyte sedimentation rate and/or C-reactive protein) and normal initial echocardiogram, are regarded as without risk of developing coronary aneurysms.

These patients should be treated with low-dose aspirin until 6-8 weeks. Further continuation of aspirin beyond 8 weeks depends on the long-term risk of myocardial ischaemia.

Seek expert advice if in doubt about ongoing inflammation.

Primary options

aspirin: 3-5 mg/kg orally once daily for 6-8 weeks

ONGOING

after initial episode: Z score always <2; no involvement at any time

1st line – discontinue low-dose aspirin and provide follow-up + advice

Back
ONGOING
|
after initial episode: Z score always <2; no involvement at any time
1st line – 

discontinue low-dose aspirin and provide follow-up + advice

Risk stratification for long-term management is based primarily on maximal coronary artery Z scores, and takes into account both past and current involvement.[1][28]

Promote healthy lifestyle and activity at every visit.

Discontinue aspirin 6 weeks after the acute episode. These patients do not need antiplatelet therapy (low-dose aspirin) beyond the recommended 6-8 weeks after onset.

Carefully assess cardiovascular risk (blood pressure, fasting lipid profile, body mass index, waist circumference, dietary and activity assessment, and smoking) and counsel at least once and preferably after 1 year after the acute illness.

Consider follow-up at 4-6 weeks after the acute episode if coronary artery imaging is suboptimal or laboratory markers of inflammation are abnormal at 1-2 weeks. Discharge patients from cardiology follow-up between 4 weeks and 12 months after disease onset, depending on individual clinical context. Further follow-up is not necessary.

Angiography is not necessary.

No restriction of physical activity beyond 8 weeks is necessary.

Standard contraception and pregnancy counselling are appropriate.[1]

after initial episode: Z score ≥2.0 to <2.5; dilation only

1st line – discontinue low-dose aspirin and provide follow-up + advice

Back
ONGOING
|
after initial episode: Z score ≥2.0 to <2.5; dilation only
1st line – 

discontinue low-dose aspirin and provide follow-up + advice

Risk stratification for long-term management is based primarily on maximal coronary artery Z scores, and takes into account both past and current involvement.[1][28]

Promote healthy lifestyle and activity at every visit.

Discontinue aspirin at 6 weeks after the acute episode if Z-score and laboratory tests are normal.[28]

Consider follow-up at 6 weeks after the acute disease episode if there are abnormalities at 1-2 weeks. Discharge from cardiology if luminal dimensions have returned to normal by 12 months after disease onset. If dilation persists, continue follow-up every 2-5 years.

Assess cardiovascular risks (blood pressure, fasting lipid profile, body mass index, waist circumference, dietary and activity assessment, and smoking) at least once and ideally at least 1 year from the acute episode.[1]

Angiography is not necessary. No restriction of physical activity beyond 8 weeks is necessary.

Standard contraception and pregnancy counselling are appropriate.[1]

after initial episode: Z score ≥2.5 to <5.0; small aneurysm

1st line – antiplatelet agent

Back
ONGOING
|
after initial episode: Z score ≥2.5 to <5.0; small aneurysm
|
current or persistent
1st line – 

antiplatelet agent

Risk stratification for long-term management is based primarily on maximal coronary artery Z scores, and takes into account both past and current involvement.[1][28]

Offer low-dose aspirin to all children with coronary artery dilation or aneurysm formation that is greater than mild (coronary artery Z score >2.5 to 5.0), at least until aneurysm regression is demonstrated.[80]

If patients cannot tolerate or are resistant to aspirin, clopidogrel is an alternative.

Primary options

aspirin: 3-5 mg/kg orally once daily

Secondary options

clopidogrel: children <2 years of age: 0.2 mg/kg orally once daily, maximum 75 mg/day; children ≥2 years of age: 1 mg/kg orally once daily, maximum 75 mg/day

Plus – follow-up + advice

Back
ONGOING
|
after initial episode: Z score ≥2.5 to <5.0; small aneurysm
|
current or persistent
Plus – 

follow-up + advice

Treatment recommended for ALL patients in selected patient group

Promote healthy lifestyle and activity at every visit.

Follow up at 6 weeks after the acute episode, after 6 months, 12 months and then annually thereafter, with ECG and echocardiogram.[28]

Assess cardiovascular risks (blood pressure, fasting lipid profile, body mass index, waist circumference, dietary and activity assessment, and smoking) at least once and ideally at least 1 year from the acute episode. Obtain a fasting lipid profile.

Assess for inducible myocardial ischaemia (stress echocardiography, stress with MRI, stress nuclear medicine, or PET) every 3-5 years, or sooner if the patient has symptoms suggestive of ischaemia or has signs suggestive of ventricular dysfunction.[28]

Consider coronary computed tomography angiography at 1 year as baseline, with further imaging with angiography every 3-5 years.[28]

No restriction of physical activity beyond 8 weeks is necessary.

Standard contraception and pregnancy counselling are appropriate.[1]

1st line – follow-up + advice

Back
ONGOING
|
after initial episode: Z score ≥2.5 to <5.0; small aneurysm
|
regression to normal Z score or dilation only
1st line – 

follow-up + advice

Risk stratification for long-term management is based primarily on maximal coronary artery Z scores, and takes into account both past and current involvement.[1][28]

Promote healthy lifestyle and activity at every visit.

Assess at 6 weeks and 1 year after the acute episode. Patients may be discharged after 5 years if stress test and coronary computed tomography angiography (CTA) are normal.[28]

Assess cardiovascular risk (blood pressure, fasting lipid profile, body mass index, waist circumference, dietary and activity assessment, and smoking) every 2 years. Obtain a follow-up fasting lipid profile.

Assess for inducible myocardial ischaemia (stress echocardiography, stress with MRI, stress nuclear medicine, or PET) every 5 years, or sooner if the patient has symptoms suggestive of ischaemia or has signs suggestive of ventricular dysfunction. Consider coronary CTA at 1 year as baseline, and consider further imaging with angiography only if there is evidence for inducible myocardial ischaemia or ventricular dysfunction.[28]

Advise patients about contraception and pregnancy as you would patients without KD.

Consider – antiplatelet agent

Back
ONGOING
|
after initial episode: Z score ≥2.5 to <5.0; small aneurysm
|
regression to normal Z score or dilation only
Consider – 

antiplatelet agent

Additional treatment recommended for SOME patients in selected patient group

Consider treating with low-dose aspirin, although it is reasonable to discontinue aspirin after coronary arteries regress to normal.[1][28]

If the patient cannot tolerate or is resistant to aspirin, clopidogrel is an alternative.

Primary options

aspirin: 3-5 mg/kg orally once daily

Secondary options

clopidogrel: children <2 years of age: 0.2 mg/kg orally once daily, maximum 75 mg/day; children ≥2 years of age: 1 mg/kg orally once daily, maximum 75 mg/day

after initial episode: Z score ≥5 to <10 (with absolute luminal dimension <8 mm); medium aneurysm

1st line – antiplatelet agent

Back
ONGOING
|
after initial episode: Z score ≥5 to <10 (with absolute luminal dimension <8 mm); medium aneurysm
|
current or persistent
1st line – 

antiplatelet agent

Risk stratification for long-term management is based primarily on maximal coronary artery Z scores, and takes into account both past and current involvement.[1][28]

Treat with low-dose aspirin. Treatment should continue at least until aneurysm regression is demonstrated.

If the patient cannot tolerate or is resistant to aspirin, clopidogrel is an alternative.

Primary options

aspirin: 3-5 mg/kg orally once daily

Secondary options

clopidogrel: children <2 years of age: 0.2 mg/kg orally once daily, maximum 75 mg/day; children ≥2 years of age: 1 mg/kg orally once daily, maximum 75 mg/day

Plus – follow-up + advice

Back
ONGOING
|
after initial episode: Z score ≥5 to <10 (with absolute luminal dimension <8 mm); medium aneurysm
|
current or persistent
Plus – 

follow-up + advice

Treatment recommended for ALL patients in selected patient group

Promote healthy lifestyle and activity at every visit.

See patients at 6 weeks after the acute disease episode, then assessed after 3 months, 6 months, and 12 months, and followed up every 12 months thereafter.[28]

Assess cardiovascular risks (blood pressure, fasting lipid profile, body mass index, waist circumference, dietary and activity assessment, and smoking) at least once and ideally at least 1 year from the episode of acute disease. Obtain a follow-up fasting lipid profile.

Assess for inducible myocardial ischaemia (stress echocardiography, stress with MRI, stress nuclear medicine, or PET) every 2-5 years, or sooner if the patient has symptoms suggestive of ischaemia or signs suggestive of ventricular dysfunction.[28]

Consider coronary computed tomography angiography at 1 year as baseline, with further imaging with angiography every 2-5 years.[28]

Advise that participation in competitive sports or high-intensity activities should be guided by results from testing for inducible myocardial ischaemia or exercise-induced arrhythmias. Restrict activities involving a risk of bodily contact, trauma, or injury for patients taking dual antiplatelet therapy.

Reproductive counselling is important for patients with a history of KD, but evidence to guide recommendations is limited.[1]​[79]​ Based on experience in clinical 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. Pregnancy in patients with residual coronary abnormalities 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]​

Consider – additional antiplatelet agent

Back
ONGOING
|
after initial episode: Z score ≥5 to <10 (with absolute luminal dimension <8 mm); medium aneurysm
|
current or persistent
Consider – 

additional antiplatelet agent

Additional treatment recommended for SOME patients in selected patient group

Consider dual antiplatelet therapy with an additional antiplatelet agent such as clopidogrel (if the patient is not already on it).[1][28]​ Treatment should continue at least until aneurysm regression is demonstrated.

If the patient is not able to tolerate or is resistant to aspirin, and is therefore already on clopidogrel, consider adding dipyridamole as an alternative. Dipyridamole is no longer generally used for long-term thromboprophylaxis. It is an alternative for aspirin in patients who are taking ibuprofen, resistant or allergic to aspirin, or at risk of Reye syndrome.[28]​​

Primary options

clopidogrel: children <2 years of age: 0.2 mg/kg orally once daily, maximum 75 mg/day; children ≥2 years of age: 1 mg/kg orally once daily, maximum 75 mg/day

Secondary options

dipyridamole: children ≥2 years of age: 2-5 mg/kg/day orally given in 3 divided doses, maximum 100 mg/dose

Consider – beta-blocker

Back
ONGOING
|
after initial episode: Z score ≥5 to <10 (with absolute luminal dimension <8 mm); medium aneurysm
|
current or persistent
Consider – 

beta-blocker

Additional treatment recommended for SOME patients in selected patient group

Beta-blockers are not part of the standard treatment of Kawasaki disease. They should be considered on an individual basis if there is concern for myocardial ischaemia.[28]

Consult a cardiology specialist for guidance on drug selection and dose.

1st line – antiplatelet agent

Back
ONGOING
|
after initial episode: Z score ≥5 to <10 (with absolute luminal dimension <8 mm); medium aneurysm
|
regression to small aneurysm
1st line – 

antiplatelet agent

Risk stratification for long-term management is based primarily on maximal coronary artery Z scores, and takes into account both past and current involvement.[1][28]

Treat with low-dose aspirin.[1][28]​ Treatment should continue at least until aneurysm regression is demonstrated.

If the patient cannot tolerate or is resistant to aspirin, clopidogrel is an alternative.

Primary options

aspirin: 3-5 mg/kg orally once daily

Secondary options

clopidogrel: children <2 years of age: 0.2 mg/kg orally once daily, maximum 75 mg/day; children ≥2 years of age: 1 mg/kg orally once daily, maximum 75 mg/day

Plus – follow-up + advice

Back
ONGOING
|
after initial episode: Z score ≥5 to <10 (with absolute luminal dimension <8 mm); medium aneurysm
|
regression to small aneurysm
Plus – 

follow-up + advice

Treatment recommended for ALL patients in selected patient group

Promote healthy lifestyle and activity at every visit.

Follow up patients at 6 weeks, 6 months, 12 months, and yearly thereafter.[28]

Assess cardiovascular risk (blood pressure, fasting lipid profile, body mass index, waist circumference, dietary and activity assessment, and smoking) every year. Obtain a follow-up fasting lipid profile.

Assess for inducible myocardial ischaemia (stress echocardiography, stress with MRI, stress nuclear medicine, or PET) every 3-5 years, or sooner if the patient has symptoms suggestive of ischaemia or has signs suggestive of ventricular dysfunction.

Consider coronary computed tomography angiography at 1 year as baseline, with further imaging with angiography every 3-5 years.[28]

Advise that participation in competitive sports or high-intensity activities should be guided by results from testing for inducible myocardial ischaemia or exercise-induced arrhythmias. Restrict activities involving a risk of bodily contact, trauma, or injury for patients taking dual antiplatelet therapy.

Reproductive counseling is important for patients with a history of KD, but evidence to guide recommendations is limited.[1]​[79]​ Advise patients as per normal about contraception, but recommend that pregnancy is supervised by a multidisciplinary team including a cardiologist who is familiar with management of patients with KD.[1]​ It may be necessary to alter thromboprophylaxis during pregnancy and delivery.

Consider – beta-blocker

Back
ONGOING
|
after initial episode: Z score ≥5 to <10 (with absolute luminal dimension <8 mm); medium aneurysm
|
regression to small aneurysm
Consider – 

beta-blocker

Additional treatment recommended for SOME patients in selected patient group

Beta-blockers are not part of the standard treatment of Kawasaki disease. They should be considered on an individual basis if there is concern for myocardial ischaemia.[28]

Consult a cardiology specialist for guidance on drug selection and dose.

1st line – antiplatelet agent

Back
ONGOING
|
after initial episode: Z score ≥5 to <10 (with absolute luminal dimension <8 mm); medium aneurysm
|
regression to normal Z score or dilation only
1st line – 

antiplatelet agent

Risk stratification for long-term management is based primarily on maximal coronary artery Z scores, and takes into account both past and current involvement.[1][28]

Treat with low-dose aspirin.[1][28]​ Treatment should continue at least until aneurysm regression is demonstrated.

If the patient cannot tolerate or is resistant to aspirin, clopidogrel is an alternative.

Primary options

aspirin: 3-5 mg/kg orally once daily

Secondary options

clopidogrel: children <2 years of age: 0.2 mg/kg orally once daily, maximum 75 mg/day; children ≥2 years of age: 1 mg/kg orally once daily, maximum 75 mg/day

Plus – follow-up + advice

Back
ONGOING
|
after initial episode: Z score ≥5 to <10 (with absolute luminal dimension <8 mm); medium aneurysm
|
regression to normal Z score or dilation only
Plus – 

follow-up + advice

Treatment recommended for ALL patients in selected patient group

Promote healthy lifestyle and activity at every visit.

Follow up at 6 weeks, 6 months, 12 months, and every 2 years thereafter.[28]

Assess cardiovascular risk (blood pressure, fasting lipid profile, body mass index, waist circumference, dietary and activity assessment, and smoking) every 2 years. Obtain a follow-up fasting lipid profile.

Assess for inducible myocardial ischaemia (stress echocardiography, stress with MRI, stress nuclear medicine, or PET) every 4-5 years, or sooner if the patient has symptoms suggestive of ischaemia or has signs suggestive of ventricular dysfunction.[28]

Consider coronary computed tomography angiography at 1 year as baseline. Further imaging with angiography may not be needed in the absence of evidence of inducible myocardial ischaemia.

No restrictions regarding contraception and pregnancy are applicable to this group of patients.[1]

after initial episode: Z score ≥10 or absolute luminal diameter ≥8 mm; large or giant aneurysm

1st line – antiplatelet agent

Back
ONGOING
|
after initial episode: Z score ≥10 or absolute luminal diameter ≥8 mm; large or giant aneurysm
|
current or persistent
1st line – 

antiplatelet agent

Risk stratification for long-term management is based primarily on maximal coronary artery Z scores, and takes into account both past and current involvement.[1][28]

Patients with evidence of large or giant aneurysms, or of coronary obstruction, are at high risk for developing myocardial ischaemia.

Treat with low-dose aspirin.[1][28]​ Treatment should continue at least until aneurysm regression is demonstrated.

If the patient cannot tolerate or is resistant to aspirin, clopidogrel is an alternative.

Primary options

aspirin: 3-5 mg/kg orally once daily

Secondary options

clopidogrel: children <2 years of age: 0.2 mg/kg orally once daily, maximum 75 mg/day; children ≥2 years of age: 1 mg/kg orally once daily, maximum 75 mg/day

Plus – anticoagulant

Back
ONGOING
|
after initial episode: Z score ≥10 or absolute luminal diameter ≥8 mm; large or giant aneurysm
|
current or persistent
Plus – 

anticoagulant

Treatment recommended for ALL patients in selected patient group

Patients with evidence of large or giant aneurysms, or of coronary obstruction, are at high risk for developing myocardial ischaemia. These patients need warfarin (to keep the INR at 2-3), a low molecular weight heparin (LMWH) such as enoxaparin (to keep anti-factor Xa level at 0.5 to 1.0 units/mL), or a direct oral anticoagulant (DOAC) such as apixaban, in addition to antiplatelet therapy.[28]

LMWH is preferred as an alternative to warfarin for infants and toddlers in whom blood drawing for INR testing is difficult.[1]

DOACs may be a safer and more convenient option compared with LMWH or warfarin, but studies have only included small numbers of patients with Kawasaki disease (KD).[81][82]​​ The 2024 American Heart Association guideline includes DOACs as an option, but suggests further studies are warranted to confirm their safety and efficacy in patients with KD.[28]

Primary options

warfarin: 0.1 to 0.2 mg/kg orally once daily for 2 days, adjust dose according to INR, maximum 10 mg/dose

OR

enoxaparin: children <2 months of age: 1.5 mg/kg subcutaneously every 12 hours, adjust dose according to anti-Xa levels; children ≥2 months of age: 1 mg/kg subcutaneously every 12 hours, adjust dose according to anti-Xa levels

OR

apixaban: consult specialist for guidance on dose

Plus – follow-up + advice

Back
ONGOING
|
after initial episode: Z score ≥10 or absolute luminal diameter ≥8 mm; large or giant aneurysm
|
current or persistent
Plus – 

follow-up + advice

Treatment recommended for ALL patients in selected patient group

Promote healthy lifestyle and activity at every visit.

Assess patients at 6 weeks, and then at 3, 6, 9 and 12 months after the acute episode and every 6-12 months thereafter.[28]

Assess cardiovascular risk (blood pressure, fasting lipid profile, body mass index, waist circumference, dietary and activity assessment, and smoking) every 6-12 months. Obtain a follow-up fasting lipid profile.

Assess for inducible myocardial ischaemia (stress echocardiography, stress with MRI, stress nuclear medicine, or PET) every 6-12 months, or sooner if the patient has symptoms suggestive of ischaemia or has signs suggestive of ventricular dysfunction.

Consider further imaging with coronary computed tomography angiography for diagnostic and prognostic purposes within 2-6 months and every 1-5 years thereafter. Invasive coronary angiography may be considered.[28]

Advise that participation in competitive sports or high-intensity activities should be guided by results from testing for inducible myocardial ischaemia or exercise-induced arrhythmias. Restrict or modify activities involving a risk of bodily contact, trauma, or injury for patients taking dual antiplatelet or anticoagulation therapy.

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. Pregnancy in patients with residual coronary abnormalities 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]​

Consider – additional antiplatelet agent

Back
ONGOING
|
after initial episode: Z score ≥10 or absolute luminal diameter ≥8 mm; large or giant aneurysm
|
current or persistent
Consider – 

additional antiplatelet agent

Additional treatment recommended for SOME patients in selected patient group

Consider dual antiplatelet therapy with aspirin and an additional antiplatelet agent such as clopidogrel (if the patient is not already on it) together with anticoagulation in the setting of very extensive or distal coronary artery aneurysms or if there is a history of coronary artery thrombosis.

If the patient is not able to tolerate or is resistant to aspirin, and is therefore already on clopidogrel, consider adding dipyridamole as an alternative. Dipyridamole is no longer generally used for long-term thromboprophylaxis. It is an alternative for aspirin in patients who are taking ibuprofen, resistant or allergic to aspirin, or at risk of Reye syndrome.[28]​​

Primary options

clopidogrel: children <2 years of age: 0.2 mg/kg orally once daily, maximum 75 mg/day; children ≥2 years of age: 1 mg/kg orally once daily, maximum 75 mg/day

Secondary options

dipyridamole: children ≥2 years of age: 2-5 mg/kg/day orally given in 3 divided doses, maximum 100 mg/dose

Consider – beta-blocker

Back
ONGOING
|
after initial episode: Z score ≥10 or absolute luminal diameter ≥8 mm; large or giant aneurysm
|
current or persistent
Consider – 

beta-blocker

Additional treatment recommended for SOME patients in selected patient group

Beta-blockers are not part of the standard treatment of Kawasaki disease. They should be considered on an individual basis if there is concern for myocardial ischaemia, particularly for patients with persistent large or giant aneurysms and/or any region of stenosis prior to aneurysm.[1][28]​​

Consult a cardiology specialist for guidance on drug selection and dose.

1st line – dual antiplatelet therapy

Back
ONGOING
|
after initial episode: Z score ≥10 or absolute luminal diameter ≥8 mm; large or giant aneurysm
|
regression to medium aneurysm
1st line – 

dual antiplatelet therapy

Risk stratification for long-term management is based primarily on maximal coronary artery Z scores, and takes into account both past and current involvement.[1][28]

Treat with low-dose aspirin plus clopidogrel. Treatment should continue at least until aneurysm regression is demonstrated.

If the patient cannot tolerate or is resistant to aspirin, clopidogrel plus dipyridamole is an alternative.

Primary options

aspirin: 3-5 mg/kg orally once daily

and

clopidogrel: children <2 years of age: 0.2 mg/kg orally once daily, maximum 75 mg/day; children ≥2 years of age: 1 mg/kg orally once daily, maximum 75 mg/day

Secondary options

clopidogrel: children <2 years of age: 0.2 mg/kg orally once daily, maximum 75 mg/day; children ≥2 years of age: 1 mg/kg orally once daily, maximum 75 mg/day

and

dipyridamole: children ≥2 years of age: 2-5 mg/kg/day orally given in 3 divided doses, maximum 100 mg/dose

Plus – follow-up + advice

Back
ONGOING
|
after initial episode: Z score ≥10 or absolute luminal diameter ≥8 mm; large or giant aneurysm
|
regression to medium aneurysm
Plus – 

follow-up + advice

Treatment recommended for ALL patients in selected patient group

Promote healthy lifestyle and activity at every visit.

Assess the patient every 6-12 months.

Assess cardiovascular risk (blood pressure, fasting lipid profile, body mass index, waist circumference, dietary and activity assessment, and smoking) every 12 months. Obtain a follow-up fasting lipid profile.

Assess for inducible myocardial ischaemia (stress echocardiography, stress with MRI, stress nuclear medicine, or PET) every 2-5 years, or sooner if the patient has symptoms suggestive of ischaemia or has signs suggestive of ventricular dysfunction.[28]​ Consider coronary computed tomography angiography at 1 year as baseline, with further imaging with angiography every 2-5 years.

Advise that participation in competitive sports or high-intensity activities should be guided by results from testing for inducible myocardial ischaemia or exercise-induced arrhythmias. Restrict or modify activities involving a risk of bodily contact, trauma, or injury for patients taking dual antiplatelet or anticoagulation therapy.

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. Pregnancy in patients with residual coronary abnormalities should be supervised by a multidisciplinary team including a cardiologist who is familiar with management of patients with KD.[1]​ It may be necessary to alter thromboprophylaxis during pregnancy and delivery.

Consider – anticoagulant

Back
ONGOING
|
after initial episode: Z score ≥10 or absolute luminal diameter ≥8 mm; large or giant aneurysm
|
regression to medium aneurysm
Consider – 

anticoagulant

Additional treatment recommended for SOME patients in selected patient group

Anticoagulation with warfarin, a low molecular weight heparin (LMWH) such as enoxaparin, or a direct oral anticoagulant (DOAC) such as apixaban may be considered for patients with large or giant aneurysms that have regressed to medium aneurysms who are at risk for thrombosis; specialist consultation may be helpful when the trade-offs between thrombosis and bleeding risk are difficult to balance.[28]​ Reduction in the lumen size can occur due to thrombosis, in which case anticoagulation is indicated.[28]

LMWH is preferred as an alternative to warfarin for infants and toddlers in whom blood drawing for INR testing is difficult.

DOACs may be a safer and more convenient option compared with LMWH or warfarin, but studies have only included small numbers of patients with Kawasaki disease (KD).[81][82]​ The 2024 American Heart Association guideline includes DOACs as an option, but suggests further studies are warranted to confirm their safety and efficacy in patients with KD.[28]

Primary options

warfarin: 0.1 to 0.2 mg/kg orally once daily for 2 days, adjust dose according to INR, maximum 10 mg/dose

OR

enoxaparin: children <2 months of age: 1.5 mg/kg subcutaneously every 12 hours, adjust dose according to anti-Xa levels; children ≥2 months of age: 1 mg/kg subcutaneously every 12 hours, adjust dose according to anti-Xa levels

OR

apixaban: consult specialist for guidance on dose

Consider – beta-blocker

Back
ONGOING
|
after initial episode: Z score ≥10 or absolute luminal diameter ≥8 mm; large or giant aneurysm
|
regression to medium aneurysm
Consider – 

beta-blocker

Additional treatment recommended for SOME patients in selected patient group

Beta-blockers are not part of the standard treatment of Kawasaki disease. They should be considered on an individual basis if there is concern for myocardial ischaemia.[1][28]​​

Consult a cardiology specialist for guidance on drug selection and dose.

1st line – antiplatelet agent

Back
ONGOING
|
after initial episode: Z score ≥10 or absolute luminal diameter ≥8 mm; large or giant aneurysm
|
regression to small aneurysm
1st line – 

antiplatelet agent

Risk stratification for long-term management is based primarily on maximal coronary artery Z scores, and takes into account both past and current involvement.[1][28]

Treat with low-dose aspirin. Treatment should continue at least until aneurysm regression is demonstrated.

If the patient cannot tolerate or is resistant to aspirin, clopidogrel is an alternative.

Primary options

aspirin: 3-5 mg/kg orally once daily

Secondary options

clopidogrel: children <2 years of age: 0.2 mg/kg orally once daily, maximum 75 mg/day; children ≥2 years of age: 1 mg/kg orally once daily, maximum 75 mg/day

Plus – follow-up + advice

Back
ONGOING
|
after initial episode: Z score ≥10 or absolute luminal diameter ≥8 mm; large or giant aneurysm
|
regression to small aneurysm
Plus – 

follow-up + advice

Treatment recommended for ALL patients in selected patient group

Promote healthy lifestyle and activity at every visit.

Assess the patient at 6 weeks, 3 months, 6 months, 9 months, 12 months, and then yearly.[28]

Assess cardiovascular risks (blood pressure, fasting lipid profile, body mass index, waist circumference, dietary and activity assessment, and smoking) every 12 months. Obtain a follow-up fasting lipid profile.

Assess for inducible myocardial ischaemia (stress echocardiography, stress with MRI, stress nuclear medicine, or PET) every 3-5 years, or sooner if the patient has symptoms suggestive of ischaemia or has signs suggestive of ventricular dysfunction. Consider coronary computed tomography angiography at 1 year as baseline, with further imaging with angiography every 3-5 years.[28]

Advise that participation in competitive sports or high-intensity activities should be guided by results from testing for inducible myocardial ischaemia or exercise-induced arrhythmias. Restrict or modify activities involving a risk of bodily contact, trauma, or injury for patients taking dual antiplatelet or anticoagulation therapy.

Advise patients as per normal about contraception, but recommend that pregnancy is supervised by a multidisciplinary team including a cardiologist, and that thromboprophylaxis may be altered during pregnancy and delivery.[1]

Consider – additional antiplatelet agent

Back
ONGOING
|
after initial episode: Z score ≥10 or absolute luminal diameter ≥8 mm; large or giant aneurysm
|
regression to small aneurysm
Consider – 

additional antiplatelet agent

Additional treatment recommended for SOME patients in selected patient group

Consider dual antiplatelet therapy with an additional antiplatelet agent such as clopidogrel (if the patient is not already on it).[28]​ Treatment should continue at least until aneurysm regression is demonstrated.

If the patient is not able to tolerate or is resistant to aspirin, and is therefore already on clopidogrel, consider adding dipyridamole as an alternative. Dipyridamole is no longer generally used for long-term thromboprophylaxis. It is an alternative for aspirin in patients who are taking ibuprofen, resistant or allergic to aspirin, or at risk of Reye syndrome.[28]​

Primary options

clopidogrel: children <2 years of age: 0.2 mg/kg orally once daily, maximum 75 mg/day; children ≥2 years of age: 1 mg/kg orally once daily, maximum 75 mg/day

Secondary options

dipyridamole: children ≥2 years of age: 2-5 mg/kg/day orally given in 3 divided doses, maximum 100 mg/dose

Consider – beta-blocker

Back
ONGOING
|
after initial episode: Z score ≥10 or absolute luminal diameter ≥8 mm; large or giant aneurysm
|
regression to small aneurysm
Consider – 

beta-blocker

Additional treatment recommended for SOME patients in selected patient group

Beta-blockers are not part of the standard treatment of Kawasaki disease. They should be considered on an individual basis if there is concern for myocardial ischaemia.[1][28]

Consult a cardiology specialist for guidance on drug selection and dose.

1st line – antiplatelet agent

Back
ONGOING
|
after initial episode: Z score ≥10 or absolute luminal diameter ≥8 mm; large or giant aneurysm
|
regression to normal Z score or dilation only
1st line – 

antiplatelet agent

Risk stratification for long-term management is based primarily on maximal coronary artery Z scores, and takes into account both past and current involvement.[1][28]

Treat with low-dose aspirin. Treatment should continue at least until aneurysm regression is demonstrated.

If the patient cannot tolerate or is resistant to aspirin, clopidogrel is an alternative.

Primary options

aspirin: 3-5 mg/kg orally once daily

Secondary options

clopidogrel: children <2 years of age: 0.2 mg/kg orally once daily, maximum 75 mg/day; children ≥2 years of age: 1 mg/kg orally once daily, maximum 75 mg/day

Plus – follow-up + advice

Back
ONGOING
|
after initial episode: Z score ≥10 or absolute luminal diameter ≥8 mm; large or giant aneurysm
|
regression to normal Z score or dilation only
Plus – 

follow-up + advice

Treatment recommended for ALL patients in selected patient group

Promote healthy lifestyle and activity at every visit.

Follow up at 6 weeks, 3 months, 6 months, 9 months, 12 months, and then every 1-2 years.

Assess cardiovascular risk (blood pressure, fasting lipid profile, body mass index, waist circumference, dietary and activity assessment, and smoking) every 2 years. Obtain a follow-up fasting lipid profile.

Assess for inducible myocardial ischaemia (stress echocardiography, stress with MRI, stress nuclear medicine, or PET) every 3-5 years, or sooner if the patient has symptoms suggestive of ischaemia or signs suggestive of ventricular dysfunction. Consider coronary computed tomography angiography at 1 year as baseline, with further imaging with angiography every 3-5 years.[28]

Advise that participation in competitive sports or high-intensity activities should be guided by results from testing for inducible myocardial ischaemia or exercise-induced arrhythmias. Restrict or modify activities involving a risk of bodily contact, trauma, or injury for patients taking dual antiplatelet or anticoagulation therapy.

Advise patients about contraception as per normal, but recommend that pregnancy is supervised by a multidisciplinary team including a cardiologist, and that thromboprophylaxis may be altered during pregnancy and delivery.[1]

Consider – discontinue thromboprophylaxis

Back
ONGOING
|
after initial episode: Z score ≥10 or absolute luminal diameter ≥8 mm; large or giant aneurysm
|
regression to normal Z score or dilation only
Consider – 

discontinue thromboprophylaxis

Additional treatment recommended for SOME patients in selected patient group

Dual antiplatelet therapy and thromboprophylaxis are generally not indicated for patients with large or giant aneurysms that have regressed to normal or dilation only.[28]​ However, patient and coronary artery characteristics may influence decisions about thromboprophylaxis.[1]

If patients are on dual antiplatelet therapy, restrict or modify risk of bodily contact or trauma.

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