I forgot about the procedure on the elbow. That could easily explain the clot and the need for thinners. It would also explain not fixing the hole. That said I am dumbfounded that his mother (in-law?) nurse found him collapsed on the floor in a confused state and didn't take him to the hospital to at least get checked out. I mean he got on a plane afterwards and wasn't until a day later when he was still having issues that they started to check him out. Wtf?
1) You don't need blood thinners for procedures / surgery of the upper extremities (shoulder, arms). You will have to have very obvious symtoms to start therapy here. A cold, blue hand that have no pulsation would be a reason.
2) You need to know the difference between the arterial and the venous system.
3) A possible blood cloth in the arterial system of the elbow would make very obvious symtoms distal of the cloth, your arm would be affected. Basically a arterial blod cloth in the arm would make everything beneath the cloth hypoxic, same with the legs (see Voukoon). They are not risk factors for stroke.
4) Surgery of the lower limb requires for you to get blood thinners but because the immobilized limb may cause venous thrombosis and you are afraid for the blood cloth to break free and wander upstreams. However the venous systems aren't leading to the brain they are leading to the lungs and you are afraid of pulmonary embolism.
5) There are very few studies that show the benefits of heart surgery in a patent foramen ovale (As Antaris mentioned). There are 2 RCT-studies on the subject soon to be released which will be very interesting to read.
6) There is a positive correlation between a patent foramen ovale and migraine / strokes which isn't fully understood yet (The RCT-studies will be welcomed).
7) A heart that is behaving awkward where blood is coagulating in the heart area (most known cause, atrial fibrillation) and a cloth is released have a high chance of following the arteriall system up towards the brain area, in those cases you most likely will get substances like warfarin (the first actual purpose of this substance was to poison rats) subscribed.
8) a long way to say; you can rule out the elbow.
9) I don't think this was a minor stroke, the minors are called transient ischemic attack (TIA) and the symptoms don't last over 24 hours.
10) He was "lucky"- feels awful to write that, sorry, the symtoms mirrors where in the brain this is taking place. In another place it might get you paralyzed on the whole half of the body. Don't think he would have been able to return if that happened.