There are limited guidelines for the management of Deep medullary vein(DMV) thrombosis in literature.We aim to present a single institute experience describing 3 cases of neonatal DMV thrombosis and different management methods and a retrospective review

DMV is a rare cause of neurological damage noted in both term and preterm infants. Although their incidence in children is not know, DMV thrombosis can occur isolated or in association with CSVT.No clinical trials or definite treatment algorithms are available for DMV thrombosis in neonates. The choice of antithrombotic therapy is therefore based on the experience of the single centers or on indications extrapolated from available guidelines on CSVT. 

Between July -August 2023, we prospectively studied 3 neonates with deep medullary vein thrombosis as evidenced by characteristic hemorrhage noted on MRI. 
We also conducted a retrospective chart review of 10 pts with deep medullary vein thrombosis noted on neuroimaging to study if anticoagulation would be indicated in this condition. 

Of the 3 patients we prospectively analysed: 1st patient- no anticoagulation was initially started given co-morbid conditions and critical illness. However, repeat imaging showed worsening of hemorrhage, thereby indicating press ion of thrombosis resulting in venous hemorrhage. Pt was therefore stared on anticoagulation with LMWH. No worsening hemorrhage was noted after. 
2nd patient- Anticoagulation was not started, and no clot progression was noted.
3rd patient- Anticoagulation was started from a cardiac standpoint. No worsening in hemorrhage was noted. 

In the retrospective review, pts were noted not have received anticoagulation and did not demonstrate worsening of venous hemorrhage. 

Anticoagulation in patient with progression of DMV thrombosis did not worsen existing hemorrhage and prevented further propagation.In patient with no worsening thrombosis, absence of anticoagulation did not result in worsening of thrombosis and likely self resolved. Anticoagulation used for a different indication did not worsen intraparenchymal hemorrhage.