Medical Management of a Large Aortic Thrombus in a Young Woman With Essential Thrombocythemia

Abstract

Aortic thrombus formation is rare in the patients with essential thrombocytosis (ET); therefore, no guidelines for its management have been established. Embolism from ET-associated large vessel thrombi is potentially lethal and has been managed surgically in a few reported cases. We describe herein a 45-year-old black woman with ET found to have a 3.5-cm, pedunculated intra-aortic thrombus at the thoracoabdominal junction. How to treat this potentially devastating aortic thrombus was a management dilemma. We believed, based on the patient's diagnosis of ET and the histology of similar thrombi in 1 reported series, that the aortic thrombus was a "white thrombus" consisting primarily of aggregated platelets with a mini-

Acute lower limb ischemia in a patient with aortic thrombus and essential thrombocytosis

“…The most frequent thrombotic complication affects the microcirculation and small-medium sized vessels, usually as erythromelalgia, digital ischemia or transient ischemic attack [2,3]. ET-aortic mural thrombus has occasionally been reported [7][8][9].…”

“…Treatment is then mandatory, but there is no standard management. The options include medical treatment with heparin anticoagulation, aspirin and cytoreductive chemotherapy [8,9], and surgical treatment, with aortic thrombectomy [7] or endovascular surgery [17,18]. (Table 1).…”

“…Fang described the thrombus resolution without the development of any severe embolic events after aspirin and hydroxyurea treatment [9]. Choukroun et al [14] suggest a gradual treatment: heparin anticoagulation as initial treatment and surgery when this is not effective.…”

“…ET-associated thrombosis in large vessels such as aorta is uncommon but has also been reported [7][8][9]. This kind of thrombus is potentially devastating and its optimal treatment remains undefined.…”