From the Guidelines
Treatment for a blood clot in the aorta typically involves immediate anticoagulation therapy with heparin, followed by catheter-directed thrombolysis using agents like alteplase, reteplase, or urokinase, as the most effective approach to restore blood flow and prevent further complications. The goal of treatment is to promptly restore distal blood flow and prevent morbidity and mortality associated with aortic thrombosis. According to the American College of Radiology 1, catheter-directed pharmacologic thrombolysis is the most extensively studied and commonly used endovascular option for treating acute iliac artery ischemia, which can be applied to aortic thrombosis as well.
Key Considerations
- Patients presenting with acute limb ischemia without contraindications to anticoagulation should receive anticoagulated therapy immediately, usually with heparin 1.
- Treatment options include a glycoprotein IIb or IIIa antagonist, catheter-directed thrombolysis, and mechanical thrombectomy 1.
- The use of mechanical techniques may allow more prompt restoration of flow and expanded use of endovascular techniques in the threatened limb 1.
- Surgical approaches should be reserved for patients in whom thrombolysis or endovascular thrombectomy failed, for situations in which an unacceptable delay due to attempted endovascular techniques jeopardizes the viability of a limb, or for nonviable limbs 1.
Treatment Approach
- Catheter-directed thrombolysis is the preferred option for occluded aortoiliac or aortofemoral bypass grafts occluded < 14 days 1.
- For native-vessel thrombosis, a trial of thrombolytic therapy is recommended for viable limbs 1.
- In cases where a guide wire can be passed across the lesion, catheter-directed thrombolysis may be instituted 1.
- In cases where a guide wire cannot be successfully passed, regional thrombolysis should be attempted 1.
Outcome and Quality of Life
- Prompt treatment of aortic thrombosis can significantly improve morbidity, mortality, and quality of life outcomes by restoring blood flow and preventing further complications 1.
- Long-term anticoagulation therapy, lifestyle modifications, and management of underlying conditions are crucial for preventing recurrent thrombotic events and improving overall quality of life.
From the FDA Drug Label
• Prophylaxis and treatment of peripheral arterial embolism The treatment for a blood clot in the aorta may involve the use of heparin as an anticoagulant to prevent further clotting.
- The treatment of peripheral arterial embolism is a listed indication for heparin, which could be relevant to a blood clot in the aorta. 2
From the Research
Treatment Options for Blood Clot in the Aorta
- Surgical reperfusion is the first line approach for treating acute aortic thrombosis (AAT) 3
- Revascularization of the ischemic organ/limb as soon as possible is the major aim in the therapy of AAT to avoid further ischemic damage 3
- If the accepting clinic has no facilities for an immediate surgical intervention, it is of primary importance that these patients should be referred to an appropriate center for further management 3
Antithrombotic and Thrombolytic Therapy
- Administration of i.v. tissue plasminogen activator (tPA) is recommended for patients with acute ischemic stroke, if treatment is initiated within 3 h of clearly defined symptom onset 4
- Early aspirin therapy is recommended for patients with acute ischemic stroke who are not receiving thrombolysis 4
- Antiplatelet therapy, such as aspirin, is recommended for patients with peripheral artery occlusive disease (PAD) 5
Role of Aspirin in Thrombolytic Therapy
- Aspirin therapy decreases mortality as well as stroke and reinfarction in suspected evolving myocardial infarction (MI) 6
- The combined use of aspirin with thrombolytic therapy yields a greater benefit than either alone in suspected evolving MI 6
- Aspirin continues to play a major role in the management of thrombotic and cardiovascular disorders 7