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CC BY 4.0 · AJP Rep 2025; 15(02): e62-e66
DOI: 10.1055/a-2566-3952
Case Report

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

Margherita Velardi 
1   Department of General Pediatrics and Pediatric Emergency, Bambino Gesù Children's Hospital, Istituto di Ricerca e Cura a Carattere Scientifico, Rome, Italy
2   Unit of Neonatology, Department of Woman and Child Health and Public Health, Catholic University of Sacred Heart, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
,
Rita Luciano
2   Unit of Neonatology, Department of Woman and Child Health and Public Health, Catholic University of Sacred Heart, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
,
Simonetta Costa 
2   Unit of Neonatology, Department of Woman and Child Health and Public Health, Catholic University of Sacred Heart, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
,
Mirta Corsello
2   Unit of Neonatology, Department of Woman and Child Health and Public Health, Catholic University of Sacred Heart, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
,
Tommaso Verdolotti
3   Institute of Radiology, Fondazione Policlinico Universitario “A. Gemelli,” IRCCS, Rome, Italy
,
Luca Massimi
4   Pediatric Neurosurgery Unit, Catholic University of Sacred Heart, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
,
Domenico M. Romeo
5   Paediatric Neurology Unit, Catholic University of Sacred Heart, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
,
Francesca Gallini
2   Unit of Neonatology, Department of Woman and Child Health and Public Health, Catholic University of Sacred Heart, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
,
Giovanni Vento
2   Unit of Neonatology, Department of Woman and Child Health and Public Health, Catholic University of Sacred Heart, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
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Abstract

Objective

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

Study Design

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.

Results

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.

Conclusion

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.

Keywords

neonatal intracranial hemorrhage - neonatal cerebral thrombosis - anticoagulant therapy - cerebral sinus venous thrombosis - treatment timing


Publication History

Received: 08 November 2023

Accepted: 18 December 2024

Accepted Manuscript online:
26 March 2025

Article published online:
21 April 2025

© 2025. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/)

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