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Patient education: Medicines after an ischemic stroke (The Basics)

Patient education: Medicines after an ischemic stroke (The Basics)

What do the medicines prescribed after an ischemic stroke do? — If you have an ischemic stroke – a stroke caused by a blocked artery in the brain – the medicines your doctor prescribes afterward can help keep you from having another stroke. Your doctor might also prescribe these same medicines after a transient ischemic attack, or "TIA". People who have TIAs are at very high risk of having a full-blown stroke, so medicines to prevent strokes are important for them, too.

How do medicines help prevent strokes? — Some strokes happen when small arteries in the brain close off because they have been damaged by high blood pressure. Other strokes happen when blood clots form inside the heart or blood vessels and then travel to an artery in the brain. These blood clots are just like the clots that stop the bleeding when you cut yourself. They are clumps of protein and blood cells that harden into a gel.

Medicines that help prevent stroke work by reducing the chances that blood vessels will be damaged and by reducing the chances that clots will form.

Which medicines might I need? — Many people who have had a stroke or TIA take 3 medicines or more. That might seem like a lot, but each of them does a different job.

Medicines to prevent blood clots or "thin" the blood reduce the chance clots will form.

Medicines that lower blood pressure help prevent the damage to blood vessels caused by high blood pressure. These medicines also help make sure the brain gets all the blood it needs.

Medicines that lower LDL ("bad") cholesterol levels, such as statins. These medicines also help keep the arteries from getting damaged, which makes it less likely that clots will form in the first place.

People with other medical conditions, such as diabetes, need different medicines to treat those conditions as well.

Whatever medicines your doctor prescribes, it's important that you take them exactly as directed (table 1). If your medicines cause unwanted side effects or if you can't afford them, talk to your doctor or nurse. They might have ways to deal with these problems.

This article has only some basic information on the main medicines used to prevent strokes. For more detailed information about your medicines, ask your doctor or nurse for the patient hand-out from Lexicomp, available through UpToDate. It explains how to use each medicine, describes its possible side effects, and lists other medicines or foods that can affect how it works.

Medicines to prevent blood clots — When blood clots form inside the heart or blood vessels, they can travel to arteries in the brain and block the flow of blood. Medicines to prevent clots help keep this from happening. These medicines are especially important in people who have a heart condition called atrial fibrillation, because they are at high risk of forming clots.

The most commonly used medicines to prevent blood clots are:

Aspirin

Clopidogrel (brand name: Plavix)

A pill that contains aspirin and another medicine called dipyridamole (brand name: Aggrenox)

Cilostazol (brand name: Pletal)

Warfarin (brand name: Jantoven)

Dabigatran (brand name: Pradaxa)

Rivaroxaban (brand name: Xarelto)

Apixaban (brand name: Eliquis)

Edoxaban (brand name: Savaysa)

Medicines to lower blood pressure — High blood pressure damages the walls of the arteries. This damage can cause small arteries in the brain to close off. It can also cause clots to form. Medicines that lower blood pressure help keep both these things from happening.

There are lots of different medicines to lower blood pressure. Some people need more than one medicine to get their blood pressure low enough. The main medicines that doctors prescribe include:

ACE inhibitors and ARBs – Angiotensin-converting enzyme inhibitors (called "ACE inhibitors") and angiotensin receptor blockers (called "ARBs") are often grouped together, because they work in similar ways. Some examples of ACE inhibitors include enalapril, captopril, and lisinopril. Some examples of ARBs include candesartan (brand name: Atacand) and valsartan (brand name: Diovan).

Calcium channel blockers – Some examples of calcium channel blockers include amlodipine (brand name: Norvasc), felodipine (brand name: Plendil) and diltiazem (brand name: Cardizem).

Diuretics (sometimes called "water pills") – Some examples of diuretics include chlorthalidone and hydrochlorothiazide (also known as HCTZ).

Statins — People who have had an ischemic stroke often have fatty deposits inside their arteries called plaques. These plaques are made up mostly of cholesterol. Statins lower cholesterol, so they reduce the chances that plaques will form. They might also help shrink plaques and make them less likely to break open.

Examples of statins include atorvastatin (brand name: Lipitor), lovastatin (brand names: Mevacor, Altoprev), pravastatin (brand name: Pravachol), rosuvastatin (brand name: Crestor), and simvastatin (brand name: Zocor).

Are there any medicines I should avoid? — Some medicines can "interact" with other medicines. Taking certain medicines can change how your medicines work or make them work less well. Your doctor or nurse will talk to you about whether you need to avoid certain prescription or over-the-counter medicines, herbs, or supplements. If you have any questions about whether it is safe to take a medicine, ask your doctor, nurse, or pharmacist.

More on this topic

Patient education: Stroke (The Basics)
Patient education: Transient ischemic attack (The Basics)
Patient education: Medicines for high blood pressure (The Basics)
Patient education: Choosing a medicine for blood clots (The Basics)
Patient education: Taking medicines for blood clots (The Basics)
Patient education: Medicines for atrial fibrillation (The Basics)
Patient education: Low-sodium diet (The Basics)
Patient education: Coping with high drug prices (The Basics)

Patient education: Ischemic stroke treatment (Beyond the Basics)
Patient education: High cholesterol and lipids (Beyond the Basics)
Patient education: Aspirin in the primary prevention of cardiovascular disease and cancer (Beyond the Basics)
Patient education: High blood pressure treatment in adults (Beyond the Basics)
Patient education: Transient ischemic attack (Beyond the Basics)

This topic retrieved from UpToDate on: Mar 03, 2022.
This generalized information is a limited summary of diagnosis, treatment, and/or medication information. It is not meant to be comprehensive and should be used as a tool to help the user understand and/or assess potential diagnostic and treatment options. It does NOT include all information about conditions, treatments, medications, side effects, or risks that may apply to a specific patient. It is not intended to be medical advice or a substitute for the medical advice, diagnosis, or treatment of a health care provider based on the health care provider's examination and assessment of a patient's specific and unique circumstances. Patients must speak with a health care provider for complete information about their health, medical questions, and treatment options, including any risks or benefits regarding use of medications. This information does not endorse any treatments or medications as safe, effective, or approved for treating a specific patient. UpToDate, Inc. and its affiliates disclaim any warranty or liability relating to this information or the use thereof. The use of this information is governed by the Terms of Use, available at https://www.wolterskluwer.com/en/know/clinical-effectiveness-terms ©2022 UpToDate, Inc. and its affiliates and/or licensors. All rights reserved.
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