SHM Converge Scientific Abstract ePoster Gallery-A Case of an Aortic Mural Thrombus Treated With Direct Oral Anticoagulants

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This case report describes a 51-year-old man with a history of tobacco use who presented after a motor vehicle accident with left flank pain. CT angiography of the abdomen and pelvis revealed an infrarenal abdominal aortic mural thrombus without aneurysmal dilation or dissection. Because mural thrombi can embolize and cause stroke or limb ischemia, he was started on a heparin drip while clinicians evaluated possible risk factors.<br /><br />The patient had elevated LDL (173) and a mildly elevated A1c (5.7) and smoked 0.5 pack per day. He was counseled on smoking cessation and started on atorvastatin 40 mg daily. On hospital day 2, he was transitioned from heparin to rivaroxaban using the standard loading regimen of 15 mg twice daily for 21 days, followed by 20 mg daily. Anticoagulation was stopped after 6 months without complications or need for surgery, and he continues follow-up with vascular surgery and lifestyle modification.<br /><br />The authors note that there are no clear guidelines for managing aortic mural thrombi, especially in the absence of aneurysm or dissection. Prior reports have often used warfarin, but direct oral anticoagulants (DOACs) such as rivaroxaban may offer a more convenient alternative. This case supports the potential use of DOACs for aortic mural thrombus and highlights the need for more research comparing DOACs with warfarin in this rare condition.

Asset Subtitle

Tony M. Cheng

Meta Tag

Author List Rohit Raina, Tony M. Cheng

Category Clinical Vignettes

Concept Aortic Mural Thrombus

Concept Embolization

Concept Computed Tomography Angiography

Concept Anticoagulation

Concept Stroke

Distinguished Non-Finalist

Presenter Organization University of Tennessee Health Sciences Center

Presenting Author Tony M. Cheng

Track Adult

Keywords

aortic mural thrombus

infrarenal abdominal aorta

rivaroxaban

heparin

anticoagulation

motor vehicle accident

tobacco use

hyperlipidemia

stroke risk

vascular surgery

Aortic Mural Thrombus

Embolization

Computed Tomography Angiography

Anticoagulation

Stroke