text: Thrombotic risk in children with COVID 19 infection A systematic review of the literature Coagulation and inflammatory parameters are mildly altered in children with SARS CoV 2 COVID 19 infection and laboratory evidence of a proinflammatory and procoagulant state has been noted in multisystem inflammatory syndrome in children MIS C It is not clear whether this pediatric condition is related to thrombotic events With this study we reviewed the literature for thrombotic complications in children with COVID 19 infection and MIS C We searched the Medline PubMed Advanced Search Builder Scopus Web Of Science and Google Scholar electronic databases until 1 January 2021 using the medical subject headings MeSH terms and text words their combinations and truncated synonyms THROMBOSIS OR THROMBOPHILIA AND CHILD OR CHILDREN OR INFANT AND COVID 19 OR SARS CoV 2 Inclusion criteria were children with COVID 19 or SARS COV 2 infection The search was limited to articles published in English Exclusion criteria were reviews of published studies studies published only as abstracts letters or conference proceedings discussion papers animal studies or editorials After screening for duplicates the initial search yielded 86 records 12 were case reports involving 19 children comorbidities were absent or mild in 73 7 The most common site of thrombosis the lung 21 the most often used drug was heparin 42 Two studies were an international survey n 337 patients and a large multicenter study n 186 patients with MIS C The risk of ischemic stroke in SARS CoV 2 infection 0 82 and deep venous thrombosis in MIS C 4 3 was lower in children than in adults Thrombodic or thromboembolic events are rare in pediatric patients with COVID 19 infection and MIS C Nonetheless as in adults a high index of suspicion should be maintained in children with COVID 19 infection or MIS C particularly in those with comorbidities predisposing to thrombotic events 