question: We thank Dr Kotnik and colleagues for their commentary on the American College of Rheumatology's clinical guidance for pediatric patients with multisystem inflammatory syndrome in children (MIS-C) The use of anticoagulation in this population remains an intensely debated topic with little clinical evidence to guide treatment decisions For this reason, the task force was only able to achieve consensus on recommending anticoagulation in patients with larger coronary artery aneurysms (CAAs) (z-score &gt;10) and significant cardiac dysfunction (ejection fraction &lt; 35%) based on the well-established risk for thrombosis in patients with these clinical features (1, 2)