Early Enoxaparin Treatment in a Newborn with Cerebral Venous Sinus Thrombosis and Acute Cerebellar Hemorrhage

TL;DR

A newborn with brain blood clots was successfully treated with early heparin therapy, showing potential safety and effectiveness.

Contribution

This case supports the use of early anticoagulation in neonatal cerebral venous sinus thrombosis.

Findings

Heparin therapy was initiated early without causing bleeding complications.

Neuroimaging showed complete resolution of the thrombus.

The neonate had a normal neurological exam at discharge.

Abstract

To evaluate the management of anticoagulant therapy in neonates with cerebral sinus venous thrombosis (CSVT), focusing on potential benefits and risks.

We report the case of a full-term neonate diagnosed with CSVT, highlighting the rationale for early anticoagulation with unfractionated heparin. A brief literature review supports our clinical decision-making, considering current evidence and expert consensus despite limited neonatal-specific guidelines.

Heparin therapy was started shortly after diagnosis, without hemorrhagic complications. Neuroimaging showed complete thrombus resolution. The neonate had a normal neurological examination at discharge. Follow-up confirmed overall good clinical condition and showed mild axial hypotonia and convergent strabismus suggestive of cortical visual impairment.

Management of CSVT in neonates remains debated. While heparin may carry a risk of bleeding, delaying treatment can lead to thrombus progression. Our case supports the potential safety and efficacy of early heparin use in selected patients. Tailored, risk-based decisions may improve outcomes, though further studies are needed to establish standardized protocols.

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