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Anti-platelet therapy for Kawasaki disease (KD) is often done without monitoring drug efficacy. The aim of this study was to investigate the utility of whole-blood aggregometry to evaluate the efficacy of anti-platelet therapy for KD.Of 37 late-phase KD patients included in the present study, 20 were prescribed anti-platelet drugs. Platelet-rich plasma (PRP) aggregation with collagen as the stimulus was measured using an optical aggregometer. The area under the curve of small and large size aggregations was calculated, and categorized into five classes: –2, –1, 0, 1, and 2. Whole-blood aggregation with collagen or adenosine 5′-diphosphate (ADP) as stimulus was evaluated using the platelet aggregation threshold index (PATI), which is the concentration of stimulus that induces a whole-blood aggregation rate of 50%.In both collagen- and ADP-induced aggregation, there was a negative correlation between PATI and class determination using the PRP technique (collagen, rs = −0.870, P < 0.0001; ADP, rs = −0.620, P < 0.0001). Moreover, the PATI in collagen- and ADP-induced aggregation was significantly higher in the anti-platelet drug therapy group than in the untreated group (collagen, P < 0.0001; ADP, P = 0.0002). The serum thromboxane B2 level in the anti-platelet drug therapy group was also significantly lower than that in the untreated group (P < 0.0001). PATI was significantly higher in those treated with thienopyridine drug combinations than those without drug therapy (P = 0.0036).Whole-blood aggregometry is useful for monitoring the efficacy of anti-platelet therapy for KD.