Management of Mobile Aortic Thrombus With Aspirin Monotherapy

Mobile aortic thrombus (MAT) is a rare clinical finding that can occur with or without underlying atherosclerotic or aneurysmal disease. Optimal management remains undefined due to limited data. We report the case of a 64-year-old woman with a history of sigmoid diverticulitis and methamphetamine use, incidentally found on computed tomography angiography (CTA) to have a proximal descending aortic mobile thrombus with associated splenic and right renal infarcts. Due to an elevated risk of gastrointestinal bleeding, anticoagulation was not recommended, and the patient was managed conservatively with aspirin 81mg daily and strict blood pressure control. Follow-up CTA at six months demonstrated complete thrombus resolution without recurrent embolic events. This case highlights the potential role of antiplatelet monotherapy in selected patients with MAT when anticoagulation or surgical intervention is contraindicated.