Effect of Low-Dose Aspirin Therapy on Platelet Aggregation in Kawasaki Disease

PURPOSE: Aspirin(acetylsalicylic acid) has been used to treat unstable angina and acute myocardial infarction in adults and Kawasaki disease in children. The antithrombotic effect of aspirin was attributed to its ability to inhibit platelet aggregation by inhibiting platelet cyclooxygenase, which leads to decreased thromboxane synthesis. The purpose of this study was to evaluate the effect on the platelet aggregation by low dose aspirin in Kawasaki patients and to learn the side effects of low-dose aspirin. METHODS: Fifty patients with Kawasaki disease who were treated with low-dose aspirin, and 22 normal children were studied from Jan. 1996 to Dec. 1997. The platelet count, bleeding time, clotting time, platelet aggregation test(induced by ADP, epinephrine, collagen and ristocetin) and blood aspirin level by colorimetric method were checked. RESULTS: The platelet count, bleeding time, and clotting time in the patient group were not significantly different from the control group. The mean maximum platelet aggregation was 54.4+/-12.8% induced by ADP, 15.9+/-11.7% by epinephrine, 55.5+/-23.8% by collagen, 52.6+/-32.2% by ristocetin in the patient group. It was significantly lower than the control group(P<0.05). The mean blood aspirin level in the patient group was 5.4+/-3.7mg/dl. Side effects of low-dose aspirin were bruise, epistaxis and hematuria. CONCLUSION: Low-dose aspirin therapy in patients with Kawasaki disease inhibited platelet aggregation, but attention would be needed because of the tendency to bleed in these patients. Further investigations should be focused on the subject such as the onset of the maximal antiplatelet effect and time needed for the recovery of platelet function.

The Perinatal Complications in Infants of Mothers with Gestational Diabetes Mellitus

PURPOSE: This study was performed to examine the impact of gestational diabetes mellitus (GDM) on perinatal outcomes, especially macrosomia and metabolic complications in Korean women. Subjects and METHODS: We studied perinatal outcomes of 65 women with GDM who delivered a singleton infant and were not complicated by medical disease that might effect the fetal growth, 65 women with normal glucose tolerance were selected to match subject with GDM matched to age, height, and prepregnancy weight. RESULTS: 1) Mean birth weight in infants of mothers with GDM was significantly heavier than that in infants of control mothers, even though the delivery was almost one week earlier (3524 vs. 3364gm). 2) Although length and head circumference of infants were not different between 2 groups, chest circumference and Ponderal index were significantly higher in infants of mothers with GDM. 3) The frequencies of LGA infants and macrosomia were higher in GDM group, but frequency of prematurity was not different between 2 groups. 4) The proportion of disproportionate growth among macrosomic infants was significantly higher in GDM group. 5) In infants of mothers with GDM, the frequencies of LGA infants were not significantly different between 2 groups which were separated according to the fasting glucose level measured at the time of diagnosis. 6) In infants of mothers with GDM, the frequencies of hypoglycemia, polycythemia, hypocalcemia and hyperbilirubinemia were 21.5%, 18.5%, 3.1% and 33.8% respectively. When infants of mothers with GDM were divided to 2 groups (LGA, AGA), the frequencies of polycythemia and hyperbilirubinemia in LGA infants were higher than those in AGA infants (30.8 vs. 10.3% and 50.5 vs. 23.1%, respectively). 6) There was a significant positive correlation between Ponderal index and chest circumference/head circumference ratio (r=0.37, p<0.01). CONCLUSIONS: Inspite of tight metabolic control of mothers with GDM, perinatal complications, such as macrosomia, hypoglycemia, hyperbilirubinemia were frequent in infants of mothers with GDM. In case of infants of mothers with GDM, perinatal complication should be treated earlier or prevented by careful physical examination and intensive management.