Aneurysms of saccular shape are usually associated with a slow, almost stagnant blood flow, as well as a consequent emergence of blood clots. Despite the practical importance, there is a lack of computational models that could combine platelet aggregation, precise biorheology, and blood plasma coagulation into one efficient framework. In the present study, we address both the physical and biochemical effects during thrombosis in aneurysms and blood recirculation zones. We use continuum description of the system and partial differential equation-based model that account for fluid dynamics, platelet transport, adhesion and aggregation, and biochemical cascades of plasma coagulation. The study is focused on the role of transport and accumulation of blood cells, including contact interactions between platelets and red blood cells (RBCs), coagulation cascade triggered by activated platelets, and the hematocrit-dependent blood rheology. We validated the model against known experimental benchmarks for in vitro thrombosis. The numerical simulations indicate an important role of RBCs in spatial propagation and temporal dynamics of the aneurysmal thrombus growth. The local hematocrit determines the viscosity of the RBC-rich regions. As a result, a high hematocrit slows down flow circulation and increases the presence of RBCs in the aneurysm. The intensity of the flow in the blood vessel associated with the aneurysm also affects platelet distribution in the system, as well as the steady shape of the thrombus. © 2021 Author(s).