The information provided here is meant to give you a general idea about each of the medications listed below. Only the most general side effects are included, so ask your healthcare provider if you need to take any special precautions. Use each of these medications as recommended by your healthcare provider, or according to the instructions provided. If you have further questions about usage or side effects, contact your healthcare provider.

Clot-busting medications are used in the acute period when a stroke has just begun. The window of opportunity at the present time is three hours from the onset of the attack, according to current treatment guidelines for "clot buster" therapy. During this time several other kinds of medication are also used to treat the acute consequences of a stroke.

Anticoagulant medications (called "blood thinners") are used to prevent another stroke after the first one has occurred.

Prescription Medications

Recombinant tissue plasminogen activator (rt-PA)

  • Alteplase (Activase)

Anticoagulants

  • Heparin
  • Warfarin (Coumadin)
  • Aspirin

Drugs to reduce brain swelling

  • Glucocorticoids (cortisone-like drugs, steroids)
  • Mannitol

Nerve-protecting drugs

Other drugs

Recombinant Tissue Plasminogen Activator (rt-PA)

Common names include:

  • Alteplase (Activase)

Of the several "clot-busting" agents on the market, only rt-PA is FDA-approved for treating stroke. The others are used for treating heart attacks and blood clots in other organs. These drugs work in the complex chemistry of blood clotting to dissolve the chemicals that hold blood clots together. Therefore, these drugs must be used in only the right circumstances and must be carefully controlled.

Possible side effects include:

  • Bleeding—This is particularly unwanted if the stroke already has caused bleeding (a hemorrhagic stroke). Therefore this drug cannot be used for this type of stroke. Other fragile areas, like stomach ulcers or recent surgical sites, may also bleed.
  • Rare allergic reactions and serious heart and lung events

Anticoagulants

Common names include:

  • Heparin
  • Warfarin (Coumadin)
  • Aspirin

These drugs prevent blood from clotting, rather than dissolving a clot after it has formed. They are, therefore, technically used to prevent another stroke.

Heparin

Given by injection, heparin works immediately to prevent blood clotting. If there is a risk of bleeding from an infected area or a large brain-damaged area, this medication may not be used.

Possible side effects include:

  • Bleeding
  • Allergic reactions
  • Thrombocytopenia (too few platelets)

Warfarin (Coumadin)

Warfarin prevents formation of a blood-clotting factor by interfering with vitamin K metabolism. It takes several days to have an effect. Warfarin is frequently given along with heparin; the heparin is then discontinued when the warfarin is fully active. Warfarin can be taken by mouth, but it must be controlled within very close limits to prevent unwanted bleeding.

The dose of warfarin varies widely and is regulated by frequent blood tests that check on clotting ability. These tests are done at least weekly at the beginning of treatment because there are so many interactions that can alter its effect. Warfarin has been shown to decrease the recurrence rate of embolic stroke by 65% in patients with atrial fibrillation (a common cause of embolic stroke.)

Possible side effects include:

  • Bleeding
  • Nausea, rashes, and a variety of other uncommon reactions

Aspirin

Aspirin, in addition to its pain-relieving effect, decreases blood clotting by affecting platelets. This medication has proved itself able to reduce recurring heart attacks by about 25%. Its effect on embolic stroke is about the same.

Possible side effects include:

  • Bleeding
  • Stomach irritation and bleeding
  • Occasional allergic reactions

Drugs to Reduce Brain Swelling

Common names include:

  • Glucocorticoids (cortisone-like drugs, steroids)
  • Mannitol

Glucocorticoids (Cortisone-like Drugs, Steroids)

Cortisone-like drugs, usually dexamethasone (Decadron), are used to reduce brain swelling, a common event in strokes. Dexamethasone is given either by mouth or intravenously.

Possible side effects include:

  • High blood pressure
  • High blood sugar
  • Bleeding from the gastrointestinal tract
  • Bone loss
  • Mood swings
  • Dexamethasone for brain swelling is usually used short-term to avoid the vast majority of the many cortisone-related side effects.

Mannitol

Mannitol is given intravenously, taking fluid out of the brain and passing it to the kidneys.

Possible side effects include:

  • Kidney damage
  • Disruption of the body's chemical balance

Nerve-protecting Drugs

Nerve-protecting drugs help prevent additional nerve-cell damage caused by the chemicals released from dying brain cells. These drugs are promising but not yet routinely used, as they are still being tested. One example is minocycline, a commonly prescribed antibiotic. In a recent small trial, minocyline given 6 to 24 hours following a stroke and continued for 5 days appeared to significantly improve function and reduce disability for at least 90 days compared to those who took placebo.*

Other Drugs

In treating stroke, doctors may give you other drugs as needed to:

  • Control blood pressure
  • Correct an irregular heart rhythm

Other interventions during an acute stroke include:

  • Providing adequate oxygen
  • Taking precautions to prevent choking

Special Considerations

Whenever you are taking a prescription medication, take the following precautions:

  • Take them as directed—not more, not less, not at a different time.
  • Do not stop taking them without consulting your healthcare provider.
  • Don’t share them with anyone else.
  • Know what effects and side effects to expect, and report them to your healthcare provider.
  • If you are taking more than one drug, even if it is over-the-counter, be sure to check with a physician or pharmacist about drug interactions.
  • Plan ahead for refills so you don’t run out.