There is no clear guidance from trials. My own practice has been to anticoagulate for 72 hours, then repeat the CTA. If the thrombus is no longer visible, I switch to dual anti-platelet Rx; if still there switch to DOAC for 30 days and reimage.

If there is significant brain in that territory left to harm, I would heparinize the person and transition to anticoag for 6 weeks unless another indication for longer term anti-thrombotic therapy is known. 

Very interesting question. Although there is no randomized trial to evaluate for the best management but there are 2 important questions I ask myself before considering treatment: Where is this free-floating thrombus? Cervical carotid which likely means there is a ruptured plaque and thrombus ...

In the absence of significant data, I'm sure practice patterns will vary widely. I think we all worry about a high risk of recurrent embolization in these patients. Where I've practiced, we would typically heparinize, re-evaluate for early improvement (within days to a week), and consider continued ...