Aspirin Prophylaxis in Pediatric Patients

Primary Indications for Aspirin Prophylaxis

The American Heart Association recommends high-dose aspirin 80-100 mg/kg/day divided into 4 doses for anti-inflammatory effects in the acute phase of Kawasaki disease until fever resolves for 48-72 hours 1, 2
The American Heart Association recommends low-dose aspirin 3-5 mg/kg/day (or 1-5 mg/kg/day) once daily for antiplatelet effects for 6-8 weeks in patients with Kawasaki disease without coronary abnormalities 5, 6, 1, 2
The American College of Cardiology recommends indefinite low-dose aspirin 3-5 mg/kg/day for all patients with persistent coronary artery abnormalities due to Kawasaki disease (Class I recommendation) 7, 5
The American Heart Association recommends aspirin as initial therapy for acute ischemic stroke, until dissection and cardioembolic causes are excluded (Grade 1C) 1, 2, 3
The American Heart Association recommends daily aspirin for a minimum of 2 years once dissection and cardioembolic causes are excluded in patients with acute ischemic stroke (Grade 2C) 1, 2, 3
The American Stroke Association recommends aspirin as initial therapy for Moyamoya disease, preferred over no treatment (Grade 2C) 1, 2
The American College of Chest Physicians suggests aspirin as an acceptable alternative to UFH or LMWH for initial therapy in cerebral sinovenous thrombosis, until dissection and embolic causes are excluded 1, 2, 3

The American College of Cardiology recommends aspirin or aspirin plus dipyridamole within 72 hours of ventricular assist device placement 1, 3
The American Heart Association recommends aspirin 75-100 mg daily, added to warfarin, for patients with mechanical prosthetic heart valves, with an INR target of 2.5-3.5 5, 6, 3

The American Academy of Pediatrics recommends discontinuing all aspirin regimens during influenza or varicella infection, and switching to clopidogrel or LMWH to maintain antithrombotic coverage 7, 5, 6
The American Academy of Pediatrics recommends annual influenza vaccination for all children on long-term aspirin therapy 7, 5, 6, 4
The American Heart Association warns against using ibuprofen in children taking aspirin for antiplatelet prophylaxis, as it antagonizes aspirin-induced irreversible platelet inhibition 5, 6, 4

The American Heart Association recommends echocardiography at diagnosis, 2 weeks, and 6-8 weeks after treatment for patients with Kawasaki disease 4
The American Heart Association recommends repeat cerebrovascular imaging to guide ongoing antithrombotic therapy duration in patients with stroke 1, 2
The American Heart Association recommends clinical assessment for recurrent ischemic events or TIAs in patients with stroke 1, 2

The American Academy of Pediatrics warns against failing to discontinue aspirin during influenza/varicella infections, as this is the primary cause of Reye syndrome in children on aspirin 7, 5, 6, 4
The American Heart Association warns against using ibuprofen concurrently with aspirin, as it completely negates aspirin's antiplatelet effects in patients with coronary aneurysms 5, 6, 4
The American College of Cardiology recommends against stopping aspirin too early in Kawasaki disease, as patients with any persistent coronary abnormalities require indefinite therapy 7, 5, 4