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Medications for Stroke

The information provided here is meant to give you a general idea about each of the medications listed below. Only the most general side effects are included, so ask your doctor if you need to take any special precautions. Use each of these medications as recommended by your doctor, or according to the instructions provided. If you have further questions about usage or side effects, call your doctor.

If it is determined that you had an ischemic stroke within 4½ hours of the beginning of your symptoms, you may be treated with IV clot-busting medications designed to limit damage and possibly restore blood flow to the involved areas of your brain. If it is within approximately 6 hours of the onset of your symptoms, you may be treated with intra-arterial (IA) clot-busting medications. IAs are administered via a groin incision. A catheter is advanced to the clot where medications are given directly to the clot. (These therapies are not used for hemorrhagic strokes.)

Other medications are given after the immediate danger has passed to prevent a second stroke or manage potential damage. Medications may include:

Recombinant tissue plasminogen activator (rt-PA)

  • Alteplase

Anticoagulants

  • Heparin
  • Warfarin
  • Dabigatran

Antiplatelet therapy

  • Aspirin
  • Clopidogrel
  • Aspirin and dipyridamole

Nerve-protecting drugs

Other drugs

Recombinant Tissue Plasminogen Activator (rt-PA)

Common name: Alteplase

Rt-PA is used for treating ischemic stroke. Other clot-busters are used for treating heart attacks and blood clots in other organs. These drugs dissolve the chemicals that hold blood clots together. Therefore, these drugs must be used in only the right circumstances and must be carefully controlled.

Possible side effects include:

  • Intracranial hemorrhage or bleeding from other fragile areas, such as stomach ulcers or recent surgical sites
  • Allergic reactions (rarely)

Anticoagulants

Common names include:

  • Heparin
  • Warfarin
  • Dabigatran
  • Rivaroxaban
  • Apixaban

These drugs prevent blood from clotting, rather than dissolving a clot after it has formed. Therefore, they are used to prevent another stroke. In some cases, anticoagulants are used to prevent a first stroke if a person is at high risk. These drugs may be used if the cause of the stroke or risk factor for having a stroke is atrial fibrillation or heart valve disease.

Heparin

Given by injection, heparin works immediately to prevent blood clotting. If there is a risk of bleeding from an infected area or a large brain-damaged area, this medication may not be used.

Possible side effects include:

Warfarin

Warfarin prevents formation of a blood-clotting factor by interfering with vitamin K metabolism. It takes several days to have an effect. Warfarin is frequently given along with heparin. The heparin is discontinued when the warfarin is fully active. Warfarin can be taken by mouth. But, it must be controlled within very close limits to prevent unwanted bleeding.

The dose of warfarin varies widely and is regulated by frequent blood tests that check on clotting ability. These tests are done at least weekly at the beginning of treatment. This is because there are so many interactions that can change its effect. Warfarin decreases the recurrence rate of embolic stroke in people with atrial fibrillation, which is a common cause of embolic stroke.

Possible side effects include:

  • Bleeding
  • Nausea
  • Rash

Dabigatran

Dabigatran is a medication that helps to prevent blood clots. It can be taken by mouth and does not require frequent blood tests.

Possible side effects include:

  • Bleeding
  • Nausea, stomach pain, or bloating
  • Rash

Rivaroxaban

Rivaraoxaban is a medication used to decrease the risk of strokes in people with irregular heartbeat known as non-valvular atrial fibrillation.

Possible side effects include bleeding.

Apixaban

Apixaban is a medication used to decrease the risk of strokes in people with irregular heartbeat known as non-valvular atrial fibrillation.

Possible side effects include bleeding.

Antiplatelet Therapy     TOP

Common names include:

  • Aspirin
  • Clopidogrel
  • Aspirin and dipyridamole

Aspirin

Aspirin, in addition to its pain-relieving effect, decreases blood clotting by affecting platelets. This medication is able to reduce recurring heart attacks by about 25%. Its effect on embolic stroke is about the same.

Possible side effects include:

  • Bleeding
  • Stomach irritation and bleeding
  • Occasional allergic reactions

Aspirin and Dipyridamole

This medication is used to reduce risk of stroke in people who have had transient ischemia attacks (TIA) or a prior stroke due to blood clots. Dipyridamole may be more effective than aspirin alone. Side effects include:

  • Headache
  • Stomach pain, heartburn
  • Nausea or vomiting
  • Diarrhea

Clopidogrel

Clopidogrel is used to prevent heart attack and stroke. Clopidogrel can be used in people who cannot take aspirin or who have a coronary stent. Possible side effects include:

  • Lightheadedness
  • Flu-like symptoms
  • Stomach pain, heartburn
  • Nausea or vomiting
  • Diarrhea
  • Headache

Nerve-protecting Drugs

Nerve-protecting drugs help prevent additional nerve-cell damage caused by the chemicals released from dying brain cells. These drugs are promising, but not yet routinely used because they are still being tested. One example is minocycline, a commonly prescribed antibiotic. It may help to improve function when given after a stroke.

Other Drugs

In treating stroke, doctors may give you other drugs as needed to:

Special Considerations    TOP

If you are taking medications, follow these general guidelines:

  • Take your medication as directed. Do not change the amount or schedule.
  • Ask what side effects could occur. Report them to your doctor.
  • Talk to your doctor before you stop taking any prescription medication.
  • Do not share your prescription medication.
  • Medications can be dangerous when mixed. Talk to your doctor or pharmacist if you are taking more than one medication, including over-the-counter products and supplements.
  • Plan ahead for refills as needed.

References:

Anticoagulation therapy for acute stroke. EBSCO DynaMed Plus website. Available at: http://www.dynamed.... Updated October 28, 2016. Accessed September 29, 2017.
Antiplatelet agents for secondary prevention of stroke. EBSCO DynaMed Plus website. Available at: http://www.dynamed.... Updated November 4, 2016. Accessed September 29, 2017.
Bushnell C, McCullough LD, Awad IA, et al. Guidelines for the prevention of stroke in women: a statement for healthcare professionals from the American Heart Association/American Stroke Association. Stroke. 2014;45(5):1545-1588. Available at:
...(Click grey area to select URL)
Accessed September 29, 2017.
Carpenter, C, Keim S, Milne W, et al. Thrombolytic therapy for acute ischemic stroke beyond three hours. J Emerg Med. 2011;40(1):82-92.
Furie KL, Kasner SE, Adams RJ, et al. Guidelines for the Prevention of Stroke in Patients With Stroke or Transient Ischemic Attack: A Guideline for Healthcare Professionals From the American Heart Association/American Stroke Association. Stroke. 2011;42(1):227-276. Available at:
...(Click grey area to select URL)
Accessed September 29, 2017.
Stroke (acute management). EBSCO DynaMed Plus website. Available at: http://www.dynamed.... Updated July 27, 2017. Accessed September 29, 2017.
Thrombolytics for acute stroke. EBSCO DynaMed Plus website. Available at: http://www.dynamed.... Updated October 28, 2016. Accessed September 29, 2017.
10/22/2007 DynaMed Plus Systematic Literature Surveillance http://www.dynamed...: Lampl Y, Boaz M, Gilad R. Minocycline treatment in acute stroke: an open-label, evaluator-blinded study. Neurology. 2007;69(14):1404-1410.
Last reviewed September 2017 by EBSCO Medical Review Board Rimas Lukas, MD
Last Updated: 12/20/2014

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