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

Why are medicines needed after an ischemic stroke? — An ischemic stroke is caused by a blocked artery in the brain. After an ischemic stroke, medicines can help improve your health and lower the risk of another stroke.

Your doctor might also prescribe these medicines after a transient ischemic attack ("TIA"). People who have a TIA 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? — Ischemic strokes happen when an artery in the brain gets clogged or closes off. This can happen if the blood vessels are damaged because of high blood pressure. It can also happen if a blood clot forms somewhere else in the body, then travels to the brain.

Medicines that help prevent stroke work by:

●Lowering the chances that blood vessels will be damaged

●Lowering the chances that blood clots will form

Which medicines might I need? — Many people who have had a stroke or TIA take 3 medicines or more. Each of them does something different to help you. Take them exactly how your doctor tells you to (table 1).

Your doctor might give you medicines that can:

●Help prevent blood clots

●Lower blood pressure

●Lower cholesterol

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

If your medicines cause side effects that bother you, or if you can't afford them, talk to your doctor or nurse. They might have ways to deal with these problems.

Medicines to prevent blood clots — When blood clots form inside the heart or blood vessels, they can travel to the brain. This can block the flow of blood and cause a stroke. Medicines to prevent blood clots help keep this from happening. This is especially important for people with atrial fibrillation. This is a heart condition that puts you at a high risk of forming clots.

Medicines that prevent blood clots include:

●Aspirin

●Clopidogrel (brand name: Plavix)

●Cilostazol (brand name: Pletal)

●Ticagrelor (brain name: Brilinta)

●A pill that contains aspirin plus a medicine called dipyridamole (brand name: Aggrenox)

●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 blood clots to form. Medicines that lower blood pressure help keep both of these things from happening.

Medicines that lower blood pressure include:

●ACE inhibitors and ARBs – These medicines are often grouped together, because they work in similar ways. Examples of ACE inhibitors include enalapril (brand names: Epaned, Vasotec), captopril, and lisinopril (brand names: Qbrelis, Zestril). Examples of ARBs include candesartan (brand name: Atacand) and valsartan (brand name: Diovan).

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

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

You might take more than 1 of these medicines.

Statins — Statins are used to treat high cholesterol. They work on fatty clumps in the arteries called "plaques." These plaques are made up of mostly cholesterol. Strokes can happen when plaques break open. When that happens, blood clots form around these plaques. Then, the blood clot can break off and travel to the brain.

Statins:

●Lower cholesterol, which lowers the chances that plaques will form

●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? — Certain medicines can change how your other medicines work or make them work less well. Your doctor or nurse will tell you if you need to avoid certain prescription or over-the-counter medicines, herbs, or supplements. If you have questions about whether it is safe to take a medicine, ask your doctor, nurse, or pharmacist.

For more detailed information about your medicines, ask your doctor or nurse for the patient handout 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.

More on this topic

Patient education: Transient ischemic attack (The Basics)
Patient education: Medicines for high blood pressure (The Basics)
Patient education: Choosing an oral medicine for blood clots (The Basics)
Patient education: Taking oral medicines for blood clots (The Basics)
Patient education: 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)