My patient had Kawasaki d. when he was 4yo, at that time, he had a giant aneurysm on left coronary artery, I've been using aspirin and anticoagultion since then, and now the aneurysm is calcifying (no thrombosis), his LDL cholesterol is 128mg/dl and he is on cholesterol diet since he was 5yo. Would anyone use statins for this patient?
Hi Fatima,
Peace and blessings.
Interesting question.
As far as I know, statins are safe and efficacious for children and adolescents (Circulation. 2007;116:594-595.). In fact statins reduce the rate of thickening of the carotid artery intima. Statins have been FDA approved for children older then 8 and 10 years old. (J Pediatr Pharmacol Ther. 2010; 15(3): 160–172.).
I have no experience of stains in 5-8 years old children. How old is he now?
he is 11yo now.. And this is the first evaluation showing calcification of coronary aneurysm. He is thin, usually keeps the low fat diet, and there's a family history of hypercholesterolemia (mother's Family)
Fátima,
I agree with Raouf HAJJI. At your discretion, I would consider statin, particularly rosuvastatin, in low dose, due to its lower risk for developing T2D in comparison to simvastatin and atorvastatin, in a long term.(http://www.ncbi.nlm.nih.gov/pubmed/25754552 - accessed on 30th March 2015)
Peace and blessings.
a view could be that you do not mind calcium in aneurysm could be protective and development of endothelial thickening would be useful.
i do not think you shd ever give children long term medication when its speculative and longterm effects unknown . no medication is without them . the question of need of antecoagulants and or aspirin more relevant after inflammatory attack on artery.
Dear Dr. Somerville, thank you very much for your comments. In fact, in Brazil we have a small number of cases of Kawasaki disease with giant aneurysms, so our experience is limited. took the case in our clinical session, and after a lot of discussion, we got to some conclusions, 1) The aneurysm is large, but comparing to other TCs, it didn't grow and cannot be considered giant anymore. 2) Although some papers from countries with higher incidence of Kawasaki disease suggest the use of statins in cases of giant aneurysms, the world experience with these drugs in children is limited and we should take a lot of care with its use, so it was our conclusion was not to begin statins at this moment and go on with diet. 3) As the aneurysm didn't grow with coronary normal growth and it cannot be considered giant anymore, we decided to stop anticoagulation and keep the child with clopidogrel and aspirin. I'd like to here the comments of you all.
Fair enough, Fatima.
And I also wish to thank Dr Somerville for sharing her wisdom with us.
Peace and blessings!