What are the guidelines for treating an aortic mural thrombus (blood clot)?

From the Guidelines

The treatment of aortic mural thrombus should prioritize anticoagulation therapy, aiming for an INR of 2.0 to 3.0 for at least 3 months and up to 1 year, as this approach has been shown to be reasonable in similar cases of left ventricular mural thrombus 1. When considering the management of aortic mural thrombus, several key points should be taken into account:

• The use of oral anticoagulation is supported by guidelines for patients with ischemic stroke or transient ischemic attack caused by an acute myocardial infarction with left ventricular mural thrombus 1.
• Aspirin can be used concurrently for ischemic coronary artery disease during oral anticoagulant therapy, in doses up to 162 mg/d 1.
• While the provided evidence specifically addresses left ventricular mural thrombus, the principles of anticoagulation therapy can be applied to aortic mural thrombus, with the goal of preventing further thrombus growth and facilitating natural thrombolysis.
• The choice of anticoagulant and duration of therapy should be individualized based on patient-specific factors, including thrombus characteristics, comorbidities, and embolic risk.
• Follow-up imaging with CT angiography or MRI should be performed to assess thrombus resolution and guide further management.
• In cases where medical therapy fails or recurrent embolization occurs, surgical intervention may be necessary, including thrombectomy, aortic repair, or endovascular stenting.

From the Research

Treatment Options for Aortic Mural Thrombus

• Anticoagulation therapy is a common treatment approach for aortic mural thrombus, with the goal of preventing further thrombus formation and reducing the risk of embolic events 2, 3.
• Surgical intervention, including thrombectomy and endovascular repair, may be considered for patients with high-risk features, such as mobile thrombus, recurrent embolism, or contraindication to anticoagulation 2, 4.
• Endovascular coverage of the aortic thrombus using stent-grafts has been shown to be an effective and safe procedure, with low recurrence and re-embolization rates 2, 5.
• Direct oral anticoagulants (DOACs) may be a viable treatment option for patients with atherosclerosis-induced aortic mural thrombus, particularly in those with aspirin resistance 6.

Factors Influencing Treatment Outcomes

• Thrombus location, size, and mobility can impact treatment outcomes, with thrombi located in the ascending aorta or arch being associated with a higher risk of recurrence 4.
• Patient demographics, comorbidities, and clinical presentation can also influence treatment outcomes, with younger patients and those with underlying pro-thrombotic disorders being at higher risk for complications 2, 4.
• The presence of underlying atherosclerosis or pro-thrombotic conditions can impact treatment outcomes and may require additional therapeutic interventions 2, 6.

Treatment Guidelines and Recommendations

• Currently, there are no established guidelines for the treatment of aortic mural thrombus, and management should be individualized based on patient-specific factors 2, 4.
• A multidisciplinary approach, involving vascular surgeons, cardiologists, and radiologists, may be necessary to determine the best treatment strategy for each patient 2, 5.
• Further research is needed to establish evidence-based guidelines for the treatment of aortic mural thrombus and to improve patient outcomes 2, 4, 3, 5, 6.