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Stroke treatments

Research has shown several drugs to be extremely effective in the fight to prevent stroke. The most effective proven medical approaches to stroke prevention fall into three categories:

Antihypertensives

Lowering blood pressure to normal ranges can reduce the risk of stroke dramatically. Blood pressure-lowering reduces the risk of both types of stroke: ischaemic (blocked artery) and haemorrhagic (bleed in the brain). When blood pressure cannot be controlled through lifestyle modification alone, your doctor may prescribe medication to lower your blood pressure (antihypertensives).

There are many antihypertensive medicines from which your doctor can choose. If you have already had a stroke or a TIA, the use of the blood pressure lowering medicine, perindopril, in combination with indapamide, has been shown to reduce the chance of having a further stroke significantly.

Antiplatelet agents

Platelets are a component of the blood which stick together to form a plug. This platelet plug then grows to form a blood clot that is important in stopping bleeding. Antiplatelet drugs play a key role by keeping the platelets from sticking together and forming abnormal clots.

Aspirin is the antiplatelet drug most commonly prescribed to help prevent stroke. It is not recommended for use in haemorrhagic stroke. Although aspirin is a non-prescribed drug, some people can’t take aspirin because of a bleeding tendency or for other reasons.

Other antiplatelet medicines include dipyridamole, ticlopidine or clopidogrel. These medications need to be prescribed by a doctor and are for people who have had a previous stroke or TIA. Dipyridamole may be given with aspirin but clopidogrel is usually prescribed on its own. These medications can be particularly useful for people who cannot take aspirin.

Anticoagulants

Anticoagulant drugs interfere with the production of certain blood components that are necessary for the formation of blood clots. The most effective anticoagulant drug for ischaemic stroke prevention is warfarin.

Warfarin helps prevent stroke by keeping existing blood clots from growing larger and by helping to keep new clots from forming. The drug is typically prescribed for older patients with atrial fibrillation (an irregular pulse).

Stroke prevention through surgery

The two carotid arteries are the main arteries carrying blood to the brain. They can become narrowed at a point in the neck by a build-up of cholesterol and other fatty material termed 'plaque'. If your carotid arteries have become partially blocked, resulting in reduced blood flow to the brain, you may be advised to have surgery to prevent stroke, which is an operation called a 'carotid endarterectomy'.

Carotid endarterectomy involves removing the plaque from the area of narrowing and opening the artery. This improves blood flow to the brain and lowers the risk of blood clots or pieces of plaque breaking off and blocking blood flow.

It is useful for people who have severe, but not total, blockage of their carotid arteries. Sometimes both carotid arteries need surgery, but they are usually done one at a time in separate operations.

Though the results are usually very good, the carotid endarterectomy operation itself carries with it a small risk of causing stroke. In expert surgical hands, however, the benefits from the surgery outweigh the risks.  As with any major surgical procedure, carefully discuss the situation with your doctors before making a decision.

To help keep the artery open, sometimes they may surgically put in a stent, which is a small expandable tube. Again there are risks associated with this procedure so speak to your doctors before making any decisions.

Not sure what to do next?

If you are still concerned about your stroke treatments, why not use healthdirect’s online Symptom Checker to get advice on when to seek medical attention.

The Symptom Checker guides you to the next appropriate healthcare steps, whether it’s self care, talking to a health professional, going to a hospital or calling triple zero (000).

Sources: NHS Choices, UK (Stroke - Treatment), Stroke Foundation (Prevent stroke)

Last reviewed: July 2015

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