Medical Treatments for Stroke

Medical Treatments for Stroke
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There are three categories of treatments available for prevention of stroke or recurrent stroke. These include medical therapy to prevent clots, such as aspirin, clopidogrel (Plavix), ticlopidine (Ticlid), or extended release dipyridamole plus aspirin (Aggremox); blood “thinners”, such as warfarin (Coumadin); or surgical intervention with a procedure called carotid endarterectomy.

Platelet Antiaggregants
Platelet antiaggregants work by preventing blood platelets from sticking together and forming clots. The most commonly used drugs in this category are aspirin and ticlopidine (Ticlid). Aspirin has been used for several decades to reduce the risk of stroke. Studies have shown that aspirin reduces the risk of nonfatal stroke by 30%, the risk of nonfatal heart attack by 30%, and the risk of death by 15% compared with groups taking a placebo. Aspirin has the advantages of being inexpensive, generally safe, and well tolerated by most individuals.

The most common side effects are gastrointestinal irritation or bleeding. The dosage recommended by physicians in the U.S. varies between 81 and 1,300 mg/day. The appropriate dose for you should be recommended by your physician. Low doses appear as effective as higher doses and have fewer side effects. In 1998, the FDA recommended a dose of 50 to 325 mg/day. Enteric coated aspirin are best tolerated. If you are allergic to aspirin or cannot tolerate it, inform your doctor to get an alternative medication.

While ticlopidine ( Ticlid ) differs from aspirin in the way it affects the platelets, the end result is prevention of blood clotting. It is more potent than aspirin. In people with diabetes, ticlopidine has been shown to significantly inhibit platelets from sticking together. It has the added benefit of slowing the progression of background retinopathy. ( Ticlopidine is more expensive than Aspirin. )
Stroke Medication
Some of the side effects with ticlopidine are diarrhea, skin rash, and a reduction in the number of infection-fighting white blood cells in the body, which develops in about 1% of patients and is reversible if it is detected early. For this reason, blood tests to detect this potentially fatal side effect are done every 2 weeks for the first 3 months of therapy.

Anticoagulants
Anticoagulants, or blood thinners, such as heparin or warfarin (Coumadin), are another therapy to prevent stroke or recurring strokes. In general, anticoagulants are used in patients who have strokes caused by cardiac clots that break loose and lodge in the brain arteries.

Anticoagulants are also given when patients fail to respond to platelet antiaggregants. Heparin is given intravenously or by injection for a short period immediately after a stroke to prevent the blood from clotting in an area of tight narrowing of a blood vessel.

Warfarin (Coumadin) prevents the blood from clotting by inhibiting the production of some of the clotting factors in the liver. Warfarin helps prevent stroke in people with atrial fibrillation and mechanical heart valves. It may also be used after some types of heart attack to prevent stroke. It is not uncommon for patients to be given both heparin and warfarin for several days after a stroke, followed by the use of warfarin alone once the desired degree of blood thinning is reached. The main potential side effect of these agents is bleeding, either into the brain or at other sites in the body. The degree of thinning of the blood needs to be carefully and frequently monitored with blood testing. Check with your physician about the foods and medications that can affect the warfarin dose. A study reported in 2001 showed that aspirin offers a slight benefit over Wayfarin for prevention of another stroke.