The safety and effectiveness of clopidogrel versus aspirin in Kawasaki disease with mild-to-moderate liver injury

Kawasaki disease can be combined with liver injury. As a mainstay treatment for Kawasaki disease, aspirin may cause liver injury. This study aimed to compare the safety and effectiveness of clopidogrel versus aspirin in Kawasaki disease with mild-to-moderate liver injury. This study retrospectively analysed 166 children with Kawasaki disease combined with mild-to-moderate liver injury. The children treated with clopidogrel were less likely to have aggravated liver injury than those treated with aspirin (n=2/100 vs. n=13/66, P<0.001). The initial alanine aminotransferase value of the clopidogrel group was higher (131.5 [98.5, 167.5] vs. 96 [72, 133], P<0.001), while the time of alanine aminotransferase recovery to normal was similar (5 [4, 7] vs. 4 [3, 7], P=0.179). No significant fever differences observed between groups: 7.5 [6, 9] for aspirin vs. 7 [6, 8] for clopidogrel group, P=0.064. The probability of nonresponse to intravenous immunoglobulin (n=29/100 vs. n=30/66, P=0.030) and the days of hospitalization (n=6 [4, 9] vs. n=7 [5, 10], P=0.007) in the clopidogrel group were less than those in the aspirin group. In conclusion, the application of clopidogrel is potentially superior to aspirin in Kawasaki disease combined with mild-to-moderate liver injury.

Automated summary

This study compared the safety and effectiveness of clopidogrel and aspirin in treating Kawasaki disease with mild-to-moderate liver injury. It found that clopidogrel treatment reduced the risk of aggravated liver injury compared to aspirin treatment, with similar recovery time for liver enzymes and no significant difference in fever. The probability of nonresponse to immunoglobulin and the length of hospitalization were also lower in the clopidogrel group. In conclusion, clopidogrel may be superior to aspirin for Kawasaki disease with mild-to-moderate liver injury.