Sir.—I read with great interest Dr Corrigan's editorial on platelet function in Kawasaki disease.1 Medical intervention in Kawasaki disease has previously been aimed at reducing the incidence of coronary artery aneurysm formation.2,3 However, once coronary aneurysms evolve, the appropriate use of anticoagulation therapy had not been seriously discussed prior to Dr Corrigan's article. In fact, most clinicians use antiplatelet therapy exclusively (eg, low-dose aspirin and/or dipyridamole). I would like to describe the management of an infant with Kawasaki disease whose initial course was complicated by coronary artery aneurysm and myocardial ischemia, as well as severe peripheral vasculitis. His large coronary aneurysm persisted, and he was successfully treated with warfarin sodium (Coumadin) anticoagulation and low-dose aspirin therapy for more than a year following the acute illness. However, shortly following withdrawal of warfarin and substitution with dipyridamole, he developed coronary thrombosis and myocardial infarction.
Patient Report.—A 7-month-old male