Formation of the floating thrombi of the thoracic aorta in a patient with JAK2 positive myeloproliferative neoplasm during therapy with direct oral anticoagulant

Floating thrombi in the aorta are very rare and usually associated with coagulation disorder. We report a patient with longstanding, relatively good controlled myeloproliferative neoplasm (MPN) who developed floating thrombi in the thoracic aorta while taking dabigatran etexilate for thromboprophylaxis of atrial fibrillation (AF). Treatment with low molecular weight heparin was successful as patient recovered completely and control CTA showed complete resolution of the thrombi. To our knowledge, this is the first case of aortic thrombi that occurred despite dabigatran use. This raises concern that DOACs might not be efficient therapy for patients with myeloproliferative neoplasms. Another question is whether patients with polycythemia vera should continue the use of acetylsalicylic acid when anticoagulant drug is needed.