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Subdural hemorrhages associated with antithrombotic therapy in infants with cerebral atrophy

Louis T Dang1, Jordan A Shavit2, Rani K Singh3

  • 1Divisions of Pediatric Neurology, louisdan@med.umich.edu.

Pediatrics
|August 13, 2014
PubMed

Insights

Enoxaparin, a low-molecular-weight heparin, can treat infant thrombosis but may increase intracranial hemorrhage risk in infants with diffuse brain injury. Careful consideration is needed before prescribing enoxaparin to this vulnerable population.

Area of Science:

  • Pediatric Neurology
  • Neonatal Thrombosis
  • Neurocritical Care

Background:

  • Low-molecular-weight heparins like enoxaparin are standard treatments for thrombosis in infants.
  • Diffuse brain injury is a serious condition in neonates and infants.

Observation:

  • Four infants with diffuse brain injury developed cerebral venous sinus thrombosis or deep vein thrombosis.
  • These infants were treated with enoxaparin, a common anticoagulant.
  • Subdural hemorrhages were observed in all four infants following enoxaparin treatment.

Findings:

  • Enoxaparin treatment was discontinued after the development of subdural hemorrhages.
  • Two infants required urgent neurosurgical intervention for their hemorrhages.
  • Subdural hemorrhages showed improvement or resolution on follow-up neuroimaging.
  • Severe neurological deficits were noted in all infants, likely attributed to the underlying diffuse brain injury.

Implications:

  • The risk of intracranial hemorrhage from enoxaparin may be heightened in infants with diffuse brain injury.
  • Clinicians should exercise caution when considering enoxaparin for thrombosis treatment in infants with diffuse brain injury.
  • Further research is warranted to elucidate the specific risks and benefits in this patient group.

Keywords:
anticoagulantsbrain hypoxia–ischemiacerebral hemorrhageencephalomalaciaenoxaparininfantintracranial sinus thrombosissubdural hematomavenous thrombosis

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