How do structural and functional findings on echocardiogram influence your decision to anticogulate ESUS cases?

This is a great but very difficult question. It is important to remember that currently, there is NO randomized controlled trial data that provides evidence for anticoagulating patients with ESUS, and the ad hoc analysis of the Arcadia trial you mention simply does not change this.

Arcadia specifically looked at patients with evidence of atriopathy and, therefore, possible underlying atrial fibrillation, and demonstrated the same number of strokes in both the aspirin and apixaban groups. Thus, t...