Health Information

Medicine 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.

Clot-busting medications are used in the acute period when a stroke has just begun. The window of opportunity is about six hours from the start of the attack. During this time, several other kinds of medications are also used to treat the acute results of a stroke. There is a 4-½ hour time window for giving these therapies by IV.

Anticoagulant medications known as blood thinners are used to prevent another stroke after the first one has occurred.

  • Recombinant tissue plasminogen activator (rt-PA)
    • Alteplase (Activase)
  • Anticoagulants
    • Heparin
    • Warfarin (Coumadin)
    • Dabigatran (Pradaxa)
  • Antiplatelet therapies
    • Aspirin
    • Clopidogrel (Plavix)
    • Aspirin and dipyridamole (Aggrenox)
  • Nerve-protecting drugs
  • Other drugs

Recombinant Tissue Plasminogen Activator (rt-PA)

Common name: Alteplase (Activase)

Of the several clot-busting agents, only rt-PA is FDA-approved for treating stroke . The others 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:

  • Bleeding—This is particularly unwanted if the stroke already has caused bleeding as in the case of a hemorrhagic stroke. Therefore, this drug cannot be used for this type of stroke. Other fragile areas, like stomach ulcers or recent surgical sites, may also bleed.
  • Rare allergic reactions and serious heart and lung events

Anticoagulants

Common names include:

  • Heparin
  • Warfarin (Coumadin)
  • Dabigatran (Pradaxa)

These drugs prevent blood from clotting, rather than dissolving a clot after it has formed. Therefore, they are used to prevent another stroke. Sometimes, though, 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 (Coumadin)

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 patients with atrial fibrillation, which is a common cause of embolic stroke.

Possible side effects include:

  • Bleeding
  • Nausea
  • Rash
Dabigatran (Pradaxa)

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 (Xarelto)

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

Possible side effects include bleeding.

Antiplatelet Therapy

Common names include:

  • Aspirin
  • Clopidogrel (Plavix)
  • Aspirin and dipyridamole (Aggrennox)
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 (Aggrenox)

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

  • Headache
  • Stomach pain, heartburn
  • Nausea or vomiting
  • Diarrhea
Clopidogrel (Plavix)

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:

  • Control blood pressure
  • Control blood sugar levels
  • Correct an irregular heart rhythm

Special Considerations

If you are taking medications, follow these general guidelines:

  • Take your medicine as directed. Do not change the amount or the schedule.
  • Do not stop taking them without talking to your doctor.
  • Do not share them.
  • Ask what the results and side effects may be. Report them to your doctor.
  • Some drugs can be dangerous when mixed. Talk to a doctor or pharmacist if you are taking more than one drug. This includes over-the-counter medicine and herb or dietary supplements.
  • Plan ahead for refills so you do not run out.

Revision Information

  • Reviewer: Rimas Lukas, MD
  • Review Date: 11/2013 -
  • Update Date: 11/20/2013 -
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  • Antiplatelet therapy for acute stroke. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed. Updated March 7, 2013. Accessed November 20, 2013.

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  • Deep vein thrombosis (DVT) prophylaxis for medical patients. EBSCO DynaMed website. Available at: http://www.ebscohost.com. Updated August 22, 2013. Accessed November 20, 2013.

  • FDA approves Pradaxa to prevent stroke in people with atrial fibrillation. US Food and Drug Administration website. Available at: http://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm230241.htm. Published October 19, 2010. Accessed November 20, 2013.

  • FDA approves Xarelto to prevent stroke in people with common type of abnormal heart rhythm. US Food and Drug Administration website. Available at: http://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm278646.htm. Published November 4, 2011. Accessed November 20, 2013.

  • 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. 2010 October 21. Available at: http://stroke.ahajournals.org/cgi/reprint/STR.0b013e3181f7d043v1. Updated October 21, 2010. Accessed November 20, 2013.

  • Stroke (acute management). EBSCO Publishing DynaMed website. Available at: http://www.ebscohost.com/dynamed. Updated August 30, 2012. Accessed November 20, 2013.

  • Thrombolytics for acute stroke. EBSCO Publishing DynaMed website. Available at: http://www.ebscohost.com/dynamed. Updated July 25, 2013. Accessed November 20, 2013.

  • 10/22/2007 DynaMed's Systematic Literature Surveillance DynaMed's Systematic Literature Surveillance : Lampl Y, Boaz M, Gilad R. Minocycline treatment in acute stroke: an open-label, evaluator-blinded study. Neurology. 2007;69:1404-1410.