Table 6.

Antiplatelet and anticoagulation therapy in MIS-C^*

Guidance statement	Level of consensus
Low-dose aspirin (3–5 mg/kg/day; maximum 81 mg/day) should be used in patients with MIS-C and continued until the platelet count is normalized and normal coronary arteries are confirmed at >4 weeks after diagnosis. Treatment with aspirin should be avoided in patients with active bleeding, significant bleeding risk, and/or a platelet count of ≤80,000/jl.	Moderate
MIS-C patients with CAAs and a maximal z-score of 2.5–10.0 should be treated with low-dose aspirin. Patients with a z-score of ≥10.0 should be treated with low-dose aspirin and therapeutic anticoagulation with enoxaparin (factor Xa level 0.5–1.0) or warfarin.	Moderate to high
Patients with MIS-C and documented thrombosis or an EF of <35% should receive therapeutic anticoagulation with enoxaparin until at least 2 weeks after discharge from the hospital.	High
Indications for longer outpatient therapeutic enoxaparin dosing include the following: CAAs with a z-score of >10.0 (indefinite treatment), documented thrombosis (treatment for ≥3 months pending thrombus resolution), or ongoing moderate-to-severe LV dysfunction.	High
For MIS-C patients who do not meet the above criteria, the approach to antiplatelet and anticoagulation therapeutic management should be tailored to the patien’s risk for thrombosis.	High

^*MIS-C = multisystem inflammatory syndrome in children; KD = Kawasaki disease; CAAs = coronary artery aneurysms; EF = ejection fraction; LV = left ventricular.