Episode 420: 427. Kawasaki disease-no, not the motorcycle company

Today, we're talking about Kawasaki disease-no, not the motorcycle company, though sometimes treating it does feel like trying to ride one at full speed through uncertainty.
For decades, high-dose aspirin was basically the holy water of Kawasaki treatment. Eighty to a hundred milligrams per kilogram per day-because apparently, kids with vasculitis also needed a little side of tinnitus. But here's the twist: new research says... maybe we didn't need all that aspirin after all.
Researchers at one hospital decided to mix things up. First, they treated 300 kids with the traditional high-dose aspirin. Then they switched the policy and gave the next 200 kids low-dose aspirin-3 to 5 mg/kg/day. Everyone got IVIG, because we're not completely reckless.

And the results? Drumroll please-no difference.

That's right. About 20% of kids in both groups needed IVIG a second time, and their coronary arteries looked... equally fine. The median max Z-score was 1.6 in both groups. (For the non-cardiologists out there, that's comfortably under aneurysm territory, which starts at 2.0.)

Basically, the low-dose kids did just as well-and none of them had to choke down near-toxic amounts of aspirin. So, high-dose: meet low benefit. Low-dose: meet my new best friend.