Vascular imaging is mandatory in selecting optimal treatment. Brain and vascular imaging can be performed urgently if ischemia is acute, especially if the patient's conditioning is worsening. If thrombolysis is not feasible, then heparin can be given, with imaging to quickly follow. Brain and vascular imaging should always precede thrombolysis. Antiplatelet drugs are used to prevent the formation of white platelet-fibrin thrombi.
White thrombi tend to form in vascular regions of endothelial irregularity that have rapid flow.
Irregular plaques that do not create severe stenosis and irregularities on heart valves and the surface of the aorta are the most important potential sites of white thrombus formation. I am impressed by the data of Helgason et al. Aspirin is inexpensive, and its side effects are usually manageable. I advise patients to take coated aspirin or aspirin admixed with antacid and to take it with food. I avoid prescribing aspirin to patients with gastritis or peptic ulcer disease.