If you have had an ischaemic stroke, a combination of medications to treat the condition and prevent it from happening again will usually be recommended.
Some of these medications will need to be taken immediately and only for a short time, while others may only be started once the stroke has been treated and may need to be taken in the long-term.
Ischaemic strokes can often be treated using injections of a medication called alteplase that dissolves blood clots and restores the flow of blood to the brain. This use of 'clot-busting' medication is known as thrombolysis.
Alteplase is most effective if started as soon as possible after the stroke occurs and is not generally recommended if more than four and a half hours have passed because it's not clear how beneficial it is when used after this time.
However, before alteplase can be used, it is very important that a brain scan to confirm a diagnosis of an ischaemic stroke is carried out because the medication can make the bleeding that occurs in haemorrhagic strokes worse.
Most people will also be offered a regular dose of aspirin which – as well as being a painkiller – makes the cells in your blood called platelets less sticky, reducing the chances of another clot forming.
In addition to aspirin, other antiplatelet medicines such as clopidogrel and dipyridamole are also available.
Some people may also be offered an additional medication called an anticoagulant to help reduce their risk of developing further blood clots in the future.
Anticoagulants prevent blood clots by changing the chemical composition of the blood in a way that prevents clots from occurring. Warfarin, rivaroxaban, dabigatran and apixaban are examples of anticoagulants for long term use. There are also a number of anticoagulants called heparins that can only be given by injection and are used in the short-term.
Anticoagulants may be offered if you:
- have a type of irregular heartbeat called atrial fibrillation that can cause blood clots
- have a history of blood clots
- are at risk of developing clots in your leg veins – known as deep vein thrombosis (DVT) – because a stroke has left you unable to move one of your legs
If your blood pressure is too high, you may be offered medicines to lower it. Medicines that are commonly used include:
- thiazide diuretics
- angiotensin-converting enzyme (ACE) inhibitors
- calcium channel blockers
Read more about treating high blood pressure.
If the level of cholesterol in your blood is too high, you will be advised to take a medicine known as a statin. Statins reduce the level of cholesterol in your blood by blocking an enzyme (chemical) in the liver that produces cholesterol.
You may be offered a statin even if your cholesterol level is not particularly high, because a statin may help reduce your risk of stroke whatever your cholesterol level is.
Some ischaemic strokes are caused by narrowing of an artery in the neck called the carotid artery, which carries blood to the brain. The narrowing, known as carotid stenosis, is caused by a build-up of fatty plaques.
If the carotid stenosis is particularly severe, surgery may be offered to unblock the artery. This is done using a surgical technique called a carotid endarterectomy. It involves the surgeon making an incision in your neck to open up the carotid artery and remove the fatty deposits.