Dr. Manorama Rajan (Neurology) needs a second opinion on this medical case.
A 56 year- old man with no ischemic cardiomyopathy is seen in the clinic following a recent hospitalization for a small left frontal stroke.His MRI at that showed a small acute stroke in the right hemispheric white matter.Echocardiography during the hospital stay showed an ejection fraction of 25% with put evidence of intracardiac thrombus ,and ongoing cardiac monitoring has yet to reveal signs of atrial fibrillation.
Which of the following is the best next step in management ?.
A Antiplatelet or anticoagulant medication depending on hemorrhagic risk.
B Long term dual antiplatelet therapy with aspirin & clopidogrel.
C Ref to left atrial appendage occlusion.
D Referral to pacemaker placement.
E Wardarin with goal international normalized ratio of 1.5 to 2.0.