Anticoagulation Alone for Aortic Segment Treatment in Symptomatic Primary Aortic Mural Thrombus Patients

Valdivia, Andrés Reyes; Santos, África Duque; Ureña, Marta Garnica; Lozano, Asunción Romero; Sanus, E. Aracil; Guaita, Julia Ocaña; Gandaria, Claudio

doi:10.1016/j.avsg.2017.01.005

Cited by 16 publications

(12 citation statements)

References 19 publications

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“… 4 Aortic surgery or treatment with anticoagulation agents are common management strategies that have been described previously. 4 - 6 Here we describe a rare case of de novo ascending aortic mural thrombus that may or may not have contributed to the patient’s presentation and describe the first use of the newer direct oral anticoagulants in treating this phenomenon successfully.…”

Section: Discussionmentioning

confidence: 97%

Large de novo ascending aortic thrombus successfully treated with anticoagulation

Houmsse¹,

McDavid²,

Kilic³

2018

J Cardiovasc Thorac Res

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An ascending aortic thrombus is a rare source for embolic transient ischemic attack (TIA) or stroke without an associated aortic pathology. Here we describe a case of a patient who presented with generalized symptoms of headache and fatigue who, on subsequent work-up , was found to have an ascending aortic thrombus with no obvious associated aortic pathology, and was successfully treated with apixaban, a newer direct oral anticoagulant.

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Section: Discussionmentioning

confidence: 97%

Large de novo ascending aortic thrombus successfully treated with anticoagulation

Houmsse¹,

McDavid²,

Kilic³

2018

J Cardiovasc Thorac Res

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“…found that patients receiving anticoagulation, either as the primary treatment modality or after aortic surgery, were less likely to experience recurrent peripheral embolic events (odds ratio 0.3; 95% confidence interval 0.1–1) ( 10 ). An anticoagulation first approach is recommended in the setting of mild distal organ involvement ( 11 ).…”

Section: Discussionmentioning

confidence: 99%

Aortic Arch Thrombus and Pulmonary Embolism in a COVID-19 Patient

Gandotra¹,

Supariwala²,

Selim³

et al. 2021

The Journal of Emergency Medicine

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Background: Coronavirus disease 2019 (COVID-19) is associated with endothelial inflammation and a hypercoagulable state resulting in both venous and arterial thromboembolic complications. We present a case of COVID-19-associated aortic thrombus in an otherwise healthy patient. Case Report: A 53-year-old woman with no past medical history presented with a 10-day history of dyspnea, fever, and cough. Her pulse oximetry on room air was 84%. She tested positive for severe acute respiratory syndrome coronavirus 2 infection, and chest radiography revealed moderate patchy bilateral airspace opacities. Serology markers for cytokine storm were significantly elevated, with a serum D-dimer level of 8180 ng/mL (normal < 230 ng/mL). Computed tomography of the chest with i.v. contrast was positive for bilateral ground-glass opacities, scattered filling defects within the bilateral segmental and subsegmental pulmonary arteries, and a large thrombus was present at the aortic arch. The patient was admitted to the intensive care unit and successfully treated with unfractionated heparin, alteplase 50 mg, and argatroban 2 mg/kg/min. Why Should an Emergency Physician Be Aware of This?: Mural aortic thrombus is a rare but serious cause of distal embolism and is typically discovered during an evaluation of cryptogenic arterial embolization to the viscera or extremities. Patients with suspected hypercoagulable states, such as that encountered with COVID-19, should be screened for thromboembolism, and when identified, aggressively anticoagulated.

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“…After a multidisciplinary discussion, the decision was made to perform an open aortic replacement surgery the same day because of the symptomatic thromboembolic event with recent cerebral infarction and the potential harmfulness of the thrombus due to its size. Although medical treatment alone has been reported to be effective in some cases (10,11), surgical management was chosen here because of the risk of stroke recurrence and because such surgery is often offered with limited complications in aortic thrombus (12,13). Peroperative trans-esophageal ultrasound showed good left ventricular function with normal mitral and aortic valves.…”

Section: Case Descriptionmentioning

confidence: 99%

Thrombus of the Aorta and SARS-CoV-2 Infection: Cause or Trigger?

Goudot

Amrane

Ayoubi

et al. 2021

Front. Cardiovasc. Med.

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Objective: Coronavirus disease 19 is a well-established cause of rare arterial thrombosis. Nevertheless, the exact mechanism of arterial thrombosis remains to be elucidated. We herein report the case of a large floating thrombus of the aortic arch, its surgical management and histological analysis.Case: A 65-year-old patient presented to the emergency department with a suspected stroke. He was non-smoker, but presented cardiovascular risk factors, namely hypertension, type 2 diabetes and hyperlipidaemia. A computed tomography of the aorta revealed a large floating thrombus of the aortic arch, at the base of the brachiocephalic trunk, suspected to be the etiology of stroke. Therapeutic anticoagulation was immediately started. The decision was made to perform an open aortic replacement surgery because of the symptomatic thromboembolic event with recent cerebral infarction and the potential harmfulness of the thrombus due to its size. A mobile thrombus was observed at the base of the brachiocephalic trunk by echocardiography. It was attached to a small area of the upper aortic wall and had an irregular surface. Histology revealed a platelet-rich thrombus lying on an aortic atherosclerotic plaque without pronounced inflammation. No plaque ulceration was present but endothelial cell desquamation was observed consistent with plaque erosion.Conclusion: In our case, there was a thrombus lying on an atherosclerotic plaque with intact thick fibrous cap, but associated with a plaque erosion mechanism. The thrombus formation appeared more likely to relate to a very localized endothelial injury.

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Anticoagulation Alone for Aortic Segment Treatment in Symptomatic Primary Aortic Mural Thrombus Patients

Cited by 16 publications

References 19 publications

Large de novo ascending aortic thrombus successfully treated with anticoagulation

Large de novo ascending aortic thrombus successfully treated with anticoagulation

Aortic Arch Thrombus and Pulmonary Embolism in a COVID-19 Patient

Thrombus of the Aorta and SARS-CoV-2 Infection: Cause or Trigger?

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