What is the optimal antithrombotic management, if at all, in patients with incidentally identified findings of multiple silent embolic appearing cerebral infarcts?

Since anticoagulation with apixaban did not show superiority to antiplatelet therapy in the atrial cardiopathy study (ARCADIA trial), I see no reason to use anticoagulation, pending further evidence. Antiplatelet therapy and statin are indicated after an ischemic stroke.

Atrial cardiopathy is in an ...

I would start with aspirin and complete the stroke workup. The work and the etiology identified will truly guide further in terms of changing antithrombotic treatment or adding something. For example is there a thrombus or a heterogenous plaque in the aortic arch, is there an anatomic variation with...