Leijser LM, et al. - Given that anticoagulation use in neonates with transposition of the great arteries (TGA) and single ventricle physiology (SVP) for secondary stroke prevention and primary cardiovascular indications varies considerably, researchers compared neonates with TGA and SVP treated with anticoagulation vs untreated neonates regarding the risk of new postoperative brain injury. In this two-center observational cohort study of 118 term-born neonates with TGA (n = 83) and SVP (n = 35), 36 neonates (29%) received anticoagulation [11 (30%) for preoperative stroke, 20 (56%) for preoperative peripheral/intracardiac thrombus, and 5 (14%) for Blalock-Taussig shunt]. Outcomes did not reveal the anticipated benefit of preventing new perioperative brain injury using anticoagulation for preoperative stroke, preoperative thrombus, and/or Blalock-Taussig shunt. A critical necessity for rigorous randomized trials on the safety and effectiveness of anticoagulation therapy in this population is thus recognized.