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Clinical outcomes of rivaroxaban and warfarin for anticoagulation in children with giant coronary artery aneurysms after Kawasaki disease
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DOI：10.1186/s12969-026-01259-8.png)
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Abstract
En 中文
Children with giant coronary artery aneurysms (gCAA) after Kawasaki disease (KD) are at high risk of coronary artery thrombosis (CAT), associated with adverse cardiovascular events (ACEs). Long-term anticoagulation is the standard regimen, but evidence comparing rivaroxaban with warfarin in gCAA after KD remains limited. We performed a retrospective observational study at 2 pediatric centers from 2020 to 2025, enrolling children with gCAA after KD. Participants received rivaroxaban or warfarin. The primary efficacy assessment included ACEs and CAT outcomes within 6 months. CAA changes and safety outcomes were assessed. The final cohort included 30 patients, 14 treated with rivaroxaban and 16 with warfarin. ACEs were infrequent, occurring in 1 patient (7.1%) receiving rivaroxaban and 2 patients (12.5%) receiving warfarin. Among patients without CAT at baseline, new-onset CAT occurred in 1 of 10 patients (10.0%) receiving rivaroxaban and 1 of 12 patients (8.3%) receiving warfarin. Among patients with CAT at baseline, CAT resolved in 2 of 4 patients in each group. CAA progression was observed in 7 patients (50.0%) in the rivaroxaban group and 10 patients (62.5%) in the warfarin group, whereas CAA regression occurred in 6 patients (42.9%) and 5 patients (31.2%), respectively. No major bleeding or prespecified severe hypersensitivity events were observed in either group. Over the 6-month follow-up, ACEs, CAT outcomes, CAA changes, and safety outcomes were descriptively similar among children receiving rivaroxaban or warfarin. These descriptive findings require confirmation in larger prospective studies.
Keywords:
Kawasaki disease
Coronary artery aneurysms
Rivaroxaban
Warfarin
Adverse cardiovascular events
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