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Management of thrombosis in the newborn

Anthony KC Chan, MBBS, FRCPC, FRCPath
Mihir D Bhatt, MD
Section Editors
Donald H Mahoney, Jr, MD
Joseph A Garcia-Prats, MD
Deputy Editor
Carrie Armsby, MD, MPH


Thrombotic disease is uncommon in newborns. However, this disorder can cause serious morbidity. The management of neonatal thrombosis, excluding the central nervous system (CNS), is reviewed here. The pathogenesis, clinical features, and diagnosis of this disorder and CNS thromboembolic disease are discussed separately. (See "Pathogenesis, clinical features, and diagnosis of thrombosis in the newborn" and "Stroke in the newborn".)


Newborns are at risk for thrombosis because of the unique characteristics of their coagulation and fibrinolytic system as compared with older age groups, and also because of triggers such as indwelling catheters. Because these risk factors usually are transient, the recurrence risk is low. Therefore, the primary goals of treatment in this age group is to prevent further extension of the clot, which can result in end-organ damage. Rarely, a neonate has a chronic condition that predisposes to thrombosis, such as neonatal purpura fulminans; in this case, long-term prophylaxis is needed. (See 'Neonatal purpura fulminans' below.)

The management of neonatal thrombosis is extrapolated largely from data in adults. Little information is available on management strategies or the efficacy and safety of therapeutic agents in the neonatal age group. The approach to an individual infant must balance the risks and benefits.

For asymptomatic thrombosis, we suggest supportive care and close monitoring of the size of the thrombus [1]. This approach avoids development of bleeding complications that may be associated with anticoagulant or fibrinolytic therapy. If the thrombus is associated with a central venous line (CVL) or umbilical venous catheter, the catheter should be removed. If the thrombus extends, we suggest treatment [1]. Alternatively, initial treatment with anticoagulant is a reasonable option, particularly when it is not feasible to remove the catheter due to the patient's clinical condition.

For symptomatic thrombosis, we suggest treatment with anticoagulation and/or fibrinolytic agents. However, these strategies have not been studied in clinical trials, and data on outcome in neonates are sparse [2,3]. The management of less severe events also is uncertain. CVLs or umbilical venous catheters associated with thrombosis should be removed, if possible, immediately or after three to five days of anticoagulation [1]. Though there is a theoretical risk of embolism with immediate catheter removal (ie, before anticoagulation), anecdotal evidence and clinical experience suggests this is uncommon. If a central catheter is still in place on completion of therapeutic anticoagulation, we suggest treatment with a prophylactic dose of low molecular weight heparin (LMWH) until the device is removed. (See 'Dose' below.)


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