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 health care provider if you need to take any special precautions. Use each of these medications as recommended by your health care provider, or according to the instructions provided. If you have further questions about usage or side effects, contact your health care provider.
Clot-busting medications are used in the acute period when a stroke has just begun. The window of opportunity at the present time is three hours from the onset of the attack, according to current treatment guidelines for "clot buster" therapy. During this time several other kinds of medication are also used to treat the acute consequences of a stroke.
Anticoagulant medications (called "blood thinners") are used to prevent another stroke after the first one has occurred.
Prescription Medications
Recombinant tissue plasminogen activator
- Alteplase - a type of recombinant tissue plasminogen activator (rt-PA)
- Heparin
- Warfarin (Coumadin)
- Aspirin
Drugs to reduce brain swelling
- Glucocorticoids (cortisone-like drugs, steroids)
- Mannitol
Recombinant Tissue Plasminogen Activator
Common names include:
- Alteplase (Activase) - a type of recombinant tissue plasminogen activator (rt-PA)
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 - Particularly unwanted if the stroke is hemorrhagic. Therefore this drug cannot be used for treating hemorrhagic stroke. Other fragile areas like stomach ulcers or recent surgical sites may also bleed.
- Rare allergic reactions and serious heart and lung events
Anticoagulants
These drugs prevent blood from clotting, rather than dissolving a clot after it has formed. They are therefore technically used to prevent another stroke.
Heparin
Given by injection, heparin works immediately to prevent blood clotting. If there is a risk of bleeding from an infected or a large brain-damaged area it may not be used.
Possible side effects include:
- Bleeding
- Allergic reactions
- Thrombocytopenia (too few platelets)
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-clotting tests. These tests are done at least weekly at the beginning of treatment 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, rashes, and a variety of other uncommon reactions
Aspirin
Aspirin, in addition to its pain-relieving effect, decreases blood clotting by affecting platelets. It has proved itself 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
Drugs to Reduce Brain Swelling
Glucocorticoids (Cortisone-like Drugs, Steroids)
Cortisone-like drugs, usually dexamethasone (Decadron), are used to reduce brain swelling, a common event in strokes. Dexamethasone is given either by mouth or intravenously.
Possible side effects include:
- Dexamethasone for brain swelling is usually used short-term, to avoid the vast majority of the many cortisone-related side effects.
Mannitol
Mannitol is given intravenously. It takes fluid out of the brain and passes it to the kidneys.
Possible side effects include:
- Kidney damage
- Disruption of the body's chemical balance
Special Considerations
Whenever you are taking a prescription medication, take the following precautions:
- Take them as directed: not more, not less, not at a different time.
- Do not stop taking them without consulting your health care provider.
- Don't share them with anyone else.
- Know what effects and side effects to expect, and report them to your health care provider.
- If you are taking more than one drug, even if it is over-the-counter, be sure to check with a physician or pharmacist about drug interactions.
- Plan ahead for refills so you don't run out.
SOURCES:
American Heart Association
Harrison's Principles of Internal Medicine, 14th ed. McGraw-Hill;1998.
Last reviewed November 2003 by Andrew Wilner, MD, FACP
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Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.
