Carotid free-floating thrombus treated with apixaban: report of a case and review of literature

Abstract

Free-floating thrombus of the internal carotid artery is infrequent (< 1% of strokes), although its diagnosis is straightforward, its treatment represents a challenge. Based mostly on case reports, standard treatment consists of therapeutic anticoagulation, while waiting for carotid endarterectomy. Both unfractioned heparin and Vitamin K antagonists have been reported as efficaceous; nevertheless, due to its rarity, clinical trials with novel oral anticoagulants are lacking. We report a patient with cardioembolic stroke and a free-floating carotid thrombus successfully treated with apixaban.