Risk factors reported included prosthetic aortic valves,3 heparin-induced thrombocytopenia,3 protein S deficiency,12 and estrogen and progesterone hormonal therapy.10,16 Ennezat et al3 and Eguchi et al12 reported multiple thrombi attached to different sites of the ascending aorta and aortic arch, which favors the hypercoagulable state as a contributor to thrombus formation rather than local aortic wall atherosclerotic disease. Here, PROS1 is linked to hyperinsulinemic hypoglycemia, familial, 4.