Key result
Conservative medical therapy with heparin bridged to rivaroxaban successfully resolved a non-atherosclerotic aortic mural thrombus in a 54-year-old man at one month follow-up.
Case Report (n=1)
Conservative management with anticoagulation successfully resolved a rare non-atherosclerotic aortic mural thrombus in a high-surgical-risk patient with active cancer.
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May support anticoagulation in select high-risk aortic mural thrombus cases; hypothesis-generating and leaves optimal strategy open pending trials.
A 54-year-old man presented to the emergency department with acute left-sided chest pain and left upper quadrant abdominal pain. He had a significant history of squamous cell carcinoma of the lung previously treated with right pneumonectomy who ; is currently receiving adjuvant chemotherapy with cisplatin. Physical examination was remarkable for tachycardia, hypertension and mild abdominal tenderness. CT angiography revealed an aortic mural thrombus in the ascending aorta and aortic arch without dissection, aneurysm or tortuosity of the aorta. In addition, an infarction of the inferior spleen was reported. Given the high risk of surgery for this patient, he was treated conservatively with esmolol and heparin infusion. His subsequent hospital course was uneventful, and he was successfully discharged on enoxaparin therapy that was successively bridged to rivaroxaban treatment. Follow-up transesophageal echocardiography and CT angiography at one month showed no thrombus in the aorta.
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Marin‐Acevedo et al. (2017) conducted a case report in Non-atherosclerotic aortic mural thrombus (n=1). Conservative treatment (esmolol, heparin infusion, enoxaparin, rivaroxaban) was evaluated on Resolution of thrombus. Conservative medical therapy with heparin bridged to rivaroxaban successfully resolved a non-atherosclerotic aortic mural thrombus in a 54-year-old man at one month follow-up.
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