Table 5.

Recommendations for anti-platelet therapy and anticoagulation.⁶⁷

Mild disease	All patients with MIS-C should receive low-dose aspirin. Patients who have mild disease do not need thromboprophylaxis with enoxaparina unless:  (1) D-dimer ≥5 times the upper limit of normal OR  (2) additional venous thromboembolism (VTE) risk factors: age ≥12 years, obesity, complete immobilization, central line, estrogen therapy, family history of VTE
Moderate-severe disease	Recommend prophylacticb management with enoxaparin or unfractionated heparin (UH)c unless otherwise contraindicated (platelet count <50,000, fibrinogen <100 mg/dL, major bleeding)  • Once patient is clinically stable (generally when they are transferred to general pediatric ward), they can be changed to aspirin unless they meet any of the criteria listed above
Hematology consult	• Rapidly increasing D-dimers • Prior history of VTE • Patients with significant underlying medical conditions (i.e., malignancy, sickle cell disease or other hemoglobinopathy, cardiac disease, nephrotic syndrome, CF, autoimmune disease) • Patients with suspected or confirmed VTE or pulmonary embolus
Discharge recommendations	• Consider stopping anticoagulation with enoxaparin at discharge unless patient has known VTE, central line, D-dimer remains ≥5 times the upper limit of normal, or other medical conditions. All patients should continue low-dose aspirin until cardiology follow-up

^aFor patients who do not meet requirements or are contraindicated for use with enoxaparin or UH, consider early ambulation and/or the use of sequential compression devices (SCDs).

^bIf patients were previously on prophylactic dosing of enoxaparin or UH, they should be increased to treatment dosing.

^cFor initiation of heparin, consult hematology and pharmacy to dose.