9th May 2025

A 40-year-old male attends ED with sudden onset right upper limb weakness and slurred speech.

A 40-year-old male attends ED with sudden onset right upper limb weakness and slurred speech. However, his symptoms resolved entirely during his wait after triage, and he has no lasting neurological deficit. The clerking doctor diagnoses a transient ischaemic attack. 

Upon clinical questioning, the gentleman reports that this is his second episode within the last few months. On reviewing the patient’s clinical notes, a previous echocardiogram report found a large right-to-left shunt due to a previously unknown patent foramen ovale.  As a result, he was commenced on simvastatin 40mg ON and clopidogrel 75mg OM. 

The gentleman reports that he has complied with his medications since then.

Given his second presentation and clinical history, which of the following options would be the most suitable management for this gentleman?

Select the SINGLE most appropriate option from the list below. Select ONE option only.