Direct oral anticoagulant therapy as an alternative to surgery for the treatment of a patient with a floating thrombus in the ascending aorta and pulmonary embolism.

A floating thrombus in the ascending aorta was incidentally discovered in a patient with a descending thoracic aortic aneurysm and a history of alcoholism. The patient developed deep venous thrombosis and pulmonary embolism. However, he refused to undergo surgical excision of the thrombus in the ascending aorta. Therefore, treatment with rivaroxaban was administered for 3 months, and it completely dissolved the thrombus. Anticoagulant therapy may be an alternative treatment when surgery cannot be performed.