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Table 4 Cardiovascular risk stratification for patients with Kawasaki syndrome

From: Kawasaki syndrome: an intriguing disease with numerous unsolved dilemmas

Risk level Therapy Physical activity Follow-up Invasive testing
I
(no coronary artery changes)
None beyond first 6-8 weeks No restrictions beyond first 6-8 weeks Counseling at 5-year-intervals None
II
(transient coronary artery ectasia)
None beyond first 6-8 weeks No restrictions beyond first 6-8 weeks Counseling at 3-to-5-year intervals None
III
(one small medium coronary artery aneurysm)
Low-dose aspirin at least until aneurysm regression is documented For patients < 11 years: no restrictions;for patients of 11-20 years: physical activity must be guided by stress test and myocardial perfusion scan; discouraged contact or high-impact sports Annual echocardiogram + ECG; biannual stress test and myocardial perfusion scan Angiography, if non invasive tests suggest ischemia
IV
(≥1 large or giant coronary artery aneurysm or multiple aneurysms without obstruction)
Long term antiplatelet therapy and warfarin or low molecular weight heparin Contact or high-impact sports should be avoided because of risk of bleeding; other physical activity recommendations must be guided by stress test and myocardial perfusion scan Biannual echocardiogram + ECG; annual stress test and myocardial perfusion scan Angiography at 6-12 months after the disease
V
(coronary artery obstruction)
Long term low-dose aspirin, warfarin or low molecular weight heparin if giant aneurysms persist Contact or high-impact sports should be avoided because of risk of bleeding; other physical activity recommendations must be guided by stress test and myocardial perfusion scan Biannual echocardiogram + ECG; annual stress test and myocardial perfusion scan Angiography is recommended to address the best personalized therapeutic option