Clinical outcomes of rivaroxaban and warfarin for anticoagulation in children with giant coronary artery aneurysms after Kawasaki disease
- 1Department of Pediatric Cardiology, The Cardiac Development and Early Intervention Unit, The Key Laboratory of Birth Defects and Related Diseases of Women and Children, The Key Laboratory of Development and Diseases of Women and Children of Sichuan Province, West China Second University Hospital, Sichuan University, Chengdu, Sichuan 610041 China
- 2Department of Pediatrics, Key Laboratory of Birth Defects and Related Diseases of Women and Children of MOE, West China Second University Hospital, Sichuan University, No. 20, 3rd section, South Renmin Road, Chengdu, Sichuan 610041 China
- 3West China Second University Hospital (Tianfu)·Sichuan Provincial Children’s Hospital, Meishan, Sichuan China
Abstract
Background: 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.
Methods: 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.
Results: 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.
Conclusions: 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.
Supplementary Information: The online version contains supplementary material available at https://doi.org/10.1186/s12969-026-01259-8.
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BibTeX
@article{yang2026clinical,
title = {{Clinical outcomes of rivaroxaban and warfarin for anticoagulation in children with giant coronary artery aneurysms after Kawasaki disease}},
author = {Penghui Yang and Jinlin Wu and Lei Liu and Li Zhao and Jiaojiao Wan and Shuran Shao and Hongyu Duan and Fan Hu and Chuan Wang and Yimin Hua and Kaiyu Zhou and Xiaoliang Liu},
journal = {Pediatric Rheumatology},
year = {2026},
month = aug,
doi = {10.1186/s12969-026-01259-8},
url = {https://doi.org/10.1186/s12969-026-01259-8},
note = {CC BY-NC-ND 4.0},
}
RIS
TY - JOUR
TI - Clinical outcomes of rivaroxaban and warfarin for anticoagulation in children with giant coronary artery aneurysms after Kawasaki disease
AU - Penghui Yang
AU - Jinlin Wu
AU - Lei Liu
AU - Li Zhao
AU - Jiaojiao Wan
AU - Shuran Shao
AU - Hongyu Duan
AU - Fan Hu
AU - Chuan Wang
AU - Yimin Hua
AU - Kaiyu Zhou
AU - Xiaoliang Liu
PY - 2026
DA - 2026/08/10
JO - Pediatric Rheumatology
DO - 10.1186/s12969-026-01259-8
UR - https://doi.org/10.1186/s12969-026-01259-8
AB - Background: 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. Methods: 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. Results: 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. Conclusions: 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. Supplementary Information: The online version contains supplementary material available at https://doi.org/10.1186/s12969-026-01259-8.
SN - 1546-0096
ER -