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Case Reports
. 2025 May 18;17(5):e84319.
doi: 10.7759/cureus.84319. eCollection 2025 May.

Systemic Embolism From Aortic Arch Thrombus Following Warfarin Discontinuation: A Case Report

Abdelrahman N Elrefaeei  1 , Omar F Al-Nahhas  2   1 , Mohammed F Al-Nahhas  3 , Thiagarajan Jaiganesh  1
Affiliations
Case Reports

Systemic Embolism From Aortic Arch Thrombus Following Warfarin Discontinuation: A Case Report

Abdelrahman N Elrefaeei et al. Cureus. .

Abstract

We present the case of a 40-year-old female with a previous diagnosis of unprovoked deep vein thrombosis (DVT), who had been on long-term warfarin therapy but discontinued it one month before presentation. She arrived at the emergency department following two episodes of transient loss of consciousness at work, raising concerns for a possible cerebrovascular event. Further evaluation revealed evidence of systemic embolization, as she developed acute basilar artery thrombosis and left upper limb ischemia findings consistent with multiple embolic events. Computed tomography angiography (CTA) demonstrated a mural thrombus in the thoracic aorta and occlusion of the left brachial artery. The patient received intravenous recombinant tissue plasminogen activator (rTPA), followed by successful mechanical thrombectomy of the basilar artery. She was managed with systemic anticoagulation and discharged neurologically intact. This case highlights the critical importance of maintaining anticoagulation in high-risk individuals and demonstrates the potentially life-threatening consequences of abrupt discontinuation.

Keywords: anticoagulation discontinuation; basilar artery thrombosis; cerebral embolism; embolic stroke; enoxaparin; mechanical thrombectomy; mural thrombus; upper limb ischemia; warfarin cessation.

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Conflict of interest statement

Human subjects: Consent for treatment and open access publication was obtained or waived by all participants in this study. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work.

Figures

Figure 1
Figure 1. Cervico-cerebral angiogram showing a focal filling defect at the tip of the basilar artery, measuring approximately 4 mm.
Figure 2
Figure 2. Axial section of CT chest showing an eccentric mural thrombus along the superior aspect of the distal thoracic aortic arch.
Figure 3
Figure 3. CT angiography of the upper limbs showing complete occlusion of the left brachial artery, likely of embolic origin.
Figure 4
Figure 4. Post-thrombectomy cervico-cerebral angiogram.
Recanalization of the basilar artery post-thrombectomy.
Figure 5
Figure 5. Axial CT chest after 42 days of anticoagulation showing a reduction in the size of the eccentric mural thrombus.
See this image and copyright information in PMC

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