Only the basic side effects are listed for each of these medicines. Ask your doctor if you need to take any other steps. Use each of these medicines the way you are taught or based on the handout you were given. If you have questions, call your doctor.

If you had an ischemic stroke within 4 and a half hours of the start of your symptoms, you may be given IV clot-busting medicine to limit harm and try to bring back blood flow to your brain. If it is about 6 hours after the symptoms, you may be given intra-arterial (IA) clot-busting medicine. They are given through a cut made in the groin. A catheter will be lead to the clot. Medicines will be given using it. (This isn't used for hemorrhagic strokes.)

Other medicines are given after the danger has passed. They can stop you from having a second stroke and help manage harm. You may be given:

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.

Some side effects are:

  • 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 you 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. If there is a risk of bleeding, this medicine may not be used.

Some side effects are:

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. But, you will need to be watched to make sure you don't have bleeding.

The dose varies and is chosen based on blood tests that check how you clot. These tests are done weekly at the start. 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.

Some side effects are:

  • Bleeding
  • Nausea
  • Rash
Dabigatran

Dabigatran is a medicine that helps stop blood clots. It can be taken by mouth. You won't need blood tests while you are on it.

Some side effects are:

  • 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. It is able to stop future heart attacks by about a quarter. Its effect on embolic stroke is about the same.

Some side effects are:

  • Bleeding
  • Stomach irritation and bleeding
  • Some 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 can't take aspirin or who have a coronary stent . Some side effects are:

  • Lightheadedness
  • Flu-like symptoms
  • Belly pain, heartburn
  • Nausea or 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 aren't routinely used because they are still being tested. One example is minocycline, a common antibiotic. It may help to function when given after a stroke.

Other Drugs

You may also be given other drugs as needed to:

Special Considerations

If you are taking medicine:

  • Take your medicine as advised. Don't change the amount or schedule.
  • Ask what side effects could happen. Tell your doctor if you have any.
  • Talk to your doctor before you stop taking any prescription medicine.
  • Don't share your prescription medicine.
  • Medicines can be harmful when mixed. Talk to your doctor or pharmacist if you are taking more than one, including over the counter products and supplements.
  • Plan ahead for refills.

Revision Information

  • Reviewer: EBSCO Medical Review BoardRimas Lukas, MD
  • Review Date: 12/2018 -
  • Update Date: 01/16/2019 -