How would you approach antithrombotic therapy in patients with acute ischemic infarcts and a non-occlusive intracranial thrombus?  

I agree with the previous answer and can expand on a few key management nuances involving stroke size, symptom severity, and etiology. For stroke size, I typically initiate anticoagulation (heparin drip) if less than one-third of the affected territory is involved, extrapolating from tPA guidelines....

I am unaware of data on this question, but it makes sense that an intraluminal thrombus might cause further ischemia. I would favor a few days of IV heparin, followed by reimaging and switching to antiplatelet Rx if the thrombus has resolved.