Its beneficial effect is annihilated by an excess of intra- and extracranial hemorrhages. A beneficial effect of the association of low-dose heparin with aspirin was suggested by the 1ST, but remains controversial. The first question in such a patient is to reconsider the etiology of TIA or stroke. If no cause is found that is amenable to special treatment, no established guidelines are available. Some clinicians, however, prefer an alternative antiplate-let agent such as clopidogrel, ticlopidine, dipyridamole or a combination with aspirin.
Atherosclerosis is a disease that develops over several decades.
Risk factors such as smoking, hypertension, hy-perlipidemia and diabetes can lead to the development of arterial fatty streaks and fibrous plaques in individuals. Clinical disease may stay clinically silent during several years, by which time atherosclerotic plaques may have developed. Initial symptoms develop in the vascular bed in which the atherosclerotic process is most advanced. However, symptoms in one vascular bed usually indicate widespread disease with a high risk of further is-chemic events elsewhere. Cracking, rupture and fissue of atherosclerotic lesions act as stimuli for platelet activation and resultant thrombosis.