by EBSCO Medical Review Board

Here are the basics about each of the medicines below. Only common problems with them are listed.

People who have had an ischemic stroke may be given IV clot-busting medicine within 4 and a half hours of the start of symptoms. This is given to limit harm and bring back blood flow to the brain. If it has been 6 hours after the symptoms, intra-arterial (IA) clot-busting medicine may be given. It is given through an incision made in the groin. These medicines are not used with hemorrhagic strokes.

Other medicines will likely be given. They can stop a person from having a second stroke and help manage harm. Stroke treatment may include these medicines:

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 to treat ischemic stroke. Other clot-busters are used to treat heart attacks and blood clots in other organs. They break down the chemicals that hold blood clots together. They must be used at the right time and must be used safely.

Problems may be:

  • Brain hemorrhage or bleeding, such as stomach ulcers or recent surgical sites
  • Allergic reactions (rare)

Anticoagulants

Common names are:

  • Heparin
  • Warfarin
  • Dabigatran
  • Rivaroxaban
  • Apixaban

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

Heparin

Heparin is given by injection. It works right away to stop blood from clotting. In may not be used in people who have a risk of bleeding.

Problems may be:

Warfarin

Warfarin stops a blood-clotting factor from forming. It takes many days to work. It is often given with heparin. The heparin is stopped when the warfarin is active. It can be taken by mouth. A person will need to be monitored for bleeding problems.

The dose varies and is chosen based on blood tests to check clotting function. These tests are done weekly at first. This is because there are many things that can change how it works. Warfarin lowers the rate of an embolic stroke in people with atrial fibrillation. This is a common cause of embolic stroke.

Problems may be:

  • Bleeding
  • Nausea
  • Rash
Dabigatran

Dabigatran is a medicine that helps stop blood clots. It can be taken by mouth. Blood tests will not be needed while a person is taking it.

Problems may be:

  • Bleeding
  • Nausea, belly pain, or bloating
  • Rash
Rivaroxaban

This medicine lowers the risk of strokes in people with irregular heartbeat known as non-valvular atrial fibrillation.

Bleeding is a side effect that could happen.

Apixaban

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

Bleeding is a side effect that could happen.

Antiplatelet Therapy

Common names are:

  • Aspirin
  • Clopidogrel
  • Aspirin and dipyridamole
Aspirin

Aspirin lowers blood clotting by affecting platelets.

Problems may be:

  • Bleeding
  • Stomach irritation and bleeding
  • Allergic reactions
Aspirin and Dipyridamole

This medicine is used to lower the 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 are:

  • Headache
  • Belly pain, heartburn
  • Nausea or vomiting
  • Diarrhea
Clopidogrel

Clopidogrel is used to prevent heart attack and stroke. It can be used in people who cannot take aspirin or who have a coronary stent .

Problems may be:

  • Lightheadedness
  • Flu-like symptoms
  • Belly pain, heartburn
  • Nausea and vomiting
  • Diarrhea
  • Headache
Nerve-protecting Drugs

Nerve-protecting drugs help prevent more nerve-cell damage caused by the chemicals released from dying brain cells. These drugs are not routinely used because they are still being tested. One example is minocycline, a common antibiotic. It may help when given after a stroke.

Other Drugs

You may also be given other drugs as needed to:

References

Antithrombotic therapy for secondary prevention of stroke or TIA. EBSCO DynaMed website. Available at: https://www.dynamed.com/management/antithrombotic-therapy-for-secondary-prevention-of-stroke-or-tia. Accessed March 11, 2022.

Stroke. National Heart, Lung, and Blood Institute website. Available at: https://www.nhlbi.nih.gov/health-topics/stroke. Accessed March 11, 2022.

Stroke (acute management). EBSCO DynaMed website. https://www.dynamed.com/management/stroke-acute-management-1. Accessed March 11, 2022.

Thrombolytics for acute stroke. EBSCO DynaMed website. Available at: https://www.dynamed.com/management/thrombolytics-for-acute-stroke. Accessed March 11, 2022.

Revision Information

  • Reviewer: EBSCO Medical Review BoardRimas Lukas, MD
  • Review Date: 11/2021
  • Update Date: 03/11/2022