Cerebral sinovenous thrombosis in the newborn: to treat or not to treat with anti-coagulation therapy Neonatal cerebral sinovenous thrombosis (CSVT) is increasingly recognised by neonatologists, paediatricians, paediatric intensivists and paediatric neurologists in recent times due to increasing awareness and improved neuroimaging techniques. Following a confirmed diagnosis of CSVT, one of the major dilemmas for the treating physician is whether or not to extrapolate Anticoagulation therapy (ACT) related data in adults and older children to newborns and initiate ACT. A major impediment for the treating physician in starting ACT is the presence of intracranial haemorrhage (ICH) in many babies at diagnosis. Based on our current understanding of CSVT, this ICH is a result of the underlying pathophysiology of the thrombus occluding the venous system. However, due to 1) the presence of ICH at diagnosis and the fear of its worsening due to ACT and 2) the uncertainty of the effect of ACT on long term outcome from CSVT, most physicians are hesitant to offer ACT to the baby. But data now show that non-treatment (with ACT) of neonatal CSVT results in worsening (propagation) of the venous thrombus in nearly a third of babies and this is associated with increased risk of brain injury as well. The lecture will cover the controversies and challenges to anticoagulation therapy in neonatal CSVT and endeavour to provide a practical bedside approach to the management of CSVT in newborns.
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