Would you empirically elective to anticoagulate patients with a remote (i.e. >10 year) history of paroxysmal atrial fibrillation presenting with newly diagnosed CVA, presumed cardioembolic in etiology, without any documented recurrence of AF?

Yes, I would, especially if the etiology is suspicious for being cardio-embolic. As per the ACC/AHA/HRS 2019 Updated Guidelines for AF management, patients with non-sex-related CHA2DS2-VASc score of >/=1 should be offered oral anticoagulation. For this particular patient, that score would be 2.

This may be getting at the risk of CVA in post-op atrial fibrillation, which often occurs in isolated, “remote” circumstances and hasn’t historically been treated with OAC. We have more data now that AF, even when short-lived, occurring in post-operative settings does convey a similar risk of CVA lo...

Absolutely, unless of course there are contraindications.