Health Information

Medicine for Stroke

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Recombinant Tissue Plasminogen Activator (rt-PA)Anticoagulants


The information provided here is meant to give you a general idea about each of the medicines 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 medicines 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 medicines are used in the acute period when a stroke has just begun. The window of opportunity at the present time is approximately six hours from the onset of the attack, according to current treatment guidelines for "clot buster" therapy. During this time, several other kinds of medicines are also used to treat the acute consequences of a stroke. There is a 4-½ hour time window for giving these “clot busting” therapies intravenously (IV). (This time window will change as more research is done.)
Anticoagulant medicines (called "blood thinners") are used to prevent another stroke after the first one has occurred.

Recombinant Tissue Plasminogen Activator (rt-PA)

Common name: Alteplase (Activase)
Of the several "clot-busting" agents on the market, 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 work in the complex chemistry of blood clotting to 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 (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. They are, therefore, 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 medicine 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 then 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 alter its effect. Warfarin has been shown to decrease the recurrence rate of embolic stroke by 65% in patients with atrial fibrillation (a common cause of embolic stroke.)
Possible side effects include:
  • Bleeding
  • Nausea
  • Rash
Dabigatran (Pradaxa)
Dabigatran is a medicine 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 medicine approved to decrease the risk of strokes in patients with irregular heartbeat (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 medicine 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 medicine 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:
  • Dizziness
  • 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 medicines, 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.
  • Know what the results and side effects. 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.

References

Anticoagulation therapy for stroke. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed/what.php . Updated September 3, 2012. Accessed September 4, 2012.

Antiplatelet agents for acute stroke. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed/what.php . Updated September 3, 2012. Accessed September 4, 2012.

Carpenter C, Keim S, Milne W, Meurer W, Barsan W. Thrombolytic therapy for acute ischemic stroke beyond three hours. J Emerg Med . 2010; June 23rd [Epub ahead of print].

Clopidogrel. EBSCO Health Library, Lexi-PALS website. Available at: http://www.ebscohost.com/healthLibrary/ . Updated December 2009. Accessed September 4, 2012.

Deep vein thrombosis (DVT) prophylaxis for medical patients. EBSCO Publishing DynaMed website. Available at: http://www.ebscohost.com/dynamed . Updated August 30, 2012. Accessed September 4, 2012.

FDA approves Pradaxa to prevent stroke in people with atrial fibrillation. United States Food and Drug Administration website. Available at: http://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm230241.htm . Published October 19, 2010. Accessed September 4, 2012.

FDA approves Xarelto to prevent stroke in people with common type of abnormal heart rhythm. http://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm278646.htm . Accessed September 4, 2012.

Stroke treatments. American Stroke Association website. Available at: http://www.strokeassociation.org/STROKEORG/AboutStroke/Treatment/Treatment%5FUCM%5F310892%5FArticle.jsp . Accessed September 4, 2012.

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 September 4, 2012.

Stroke (acute management). EBSCO Publishing DynaMed website. Available at: http://www.ebscohost.com/dynamed . Updated August 30, 2012. Accessed September 4, 2012.

Thrombolytics for acute stroke. EBSCO Publishing DynaMed website. Available at: http://www.ebscohost.com/dynamed . Updated August 30, 2012. Accessed September 4, 2012.

Thromboembolic prophylaxis in atrial fibrillation. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed/what.php . Updated December 2009. Accessed February 4, 2010.

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.

Revision Information

  • Reviewer: Rimas Lukas, MD
  • Review Date: 09/2012 -
  • Update Date: 00/93/2012 -

This content is reviewed regularly and is updated when new and relevant evidence is made available. This information is neither intended nor implied to be a substitute for professional medical advice. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with questions regarding a medical condition.

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