Treatment and Prevention of Stroke
These are some of the strategies that can be used in stroke management:
Thrombolysis1
Ischaemic strokes can be treated using injections of a medication called alteplase that dissolves the clot and restores blood to the brain. This is known as thrombolysis.
Thrombectomy1
Some ischaemic strokes can be treated by an emergency procedure known as a thrombectomy, which is used to remove the clot and restore blood flow. It is performed by inserting a catheter into an artery, usually in the groin, and a device is then passed through the catheter to remove the clot.
What are anticoagulants? Anticoagulants play an important role in prevention of embolic strokes that are related to atrial fibrillation; find out more about them here Read more
Anticoagulant medications2,3
Anticoagulants are drugs that manipulate the blood coagulation process. They inhibit thrombus formation, meaning that they prevent blood clots from forming too easily. Anticoagulants generally include non-vitamin K antagonist oral anticoagulants (NOACs), heparins and vitamin K antagonists. All of these have different ways of working and are used to prevent stroke. Due to the pharmacological mode of action, the use of anticoagulants may be associated with an increased risk of bleeding from any tissue or organ. The signs, symptoms and severity vary according to the location of the bleeding (e.g. blood in urine, severe bruising). Your doctor will work out which anticoagulant is right for you based on the indication and the presence of any other medical conditions.
Antiplatelet medication
People who have had an ischaemic stroke may be offered aspirin, which as well as being a painkiller, is also an antiplatelet that reduces the chances of another clot forming.4
Antiplatelet medications are not used to prevent atrial fibrillation (AF)-related stroke.5 Aspirin is no longer recommended as a safe and effective stroke prevention therapy for people with AF. If you have AF and are taking aspirin alone for stroke prevention, speak with your doctor, because you may be at increased risk of stroke.5 However, due to other clinical conditions, your doctor might choose to prescribe an antiplatelet in addition to your anticoagulation therapy.5
Antihypertensive medication
If your blood pressure is too high, you may be offered medicines to lower it, including thiazide diuretics, angiotensin-converting enzyme (ACE) inhibitors, calcium channel blockers, beta-blockers or alpha-blockers.4,6 Uncontrolled hypertension might act as a risk factor for stroke and bleeding.5
Statins
If the level of cholesterol in your blood is too high, you will be advised to take statins to reduce it.4
Carotid endarterectomy
Some ischaemic strokes are caused by the narrowing of the artery in the neck called the carotid artery because of the build-up of atherosclerotic fatty deposits. In this case, surgery may be offered to remove the atherosclerotic plaque build-up.4
Craniotomy or other medication for haemorrhagic stroke
The second main type of stroke is haemorrhagic stroke, where blood leaks out of a weakened artery in the brain.1 Haemorrhagic strokes can be treated with both surgery and medication. Sometimes blood from the brain will need to be removed surgically in a procedure known as a craniotomy.4 In addition, medication will be offered to lower the blood pressure, and if anticoagulants were taken before the haemorrhagic stroke their effects will need to be reversed.4,6
Managing atrial fibrillation
Rate controllers (antiarrhythmic drugs) – rate-control medications help slow the heart rate to its regular number of beats per minute.7,8
What Is Atrial Fibrillation? This article discusses rate and rhythm controllers and how these are used to help manage atrial fibrillation. Read more
Rhythm controllers (antiarrhythmic drugs) – rhythm controllers help re-establish and maintain the heart’s normal rhythm.8
Electrical cardioversion – low energy shocks are given to the heart to try to return it to a normal rhythm.8
Radiofrequency or catheter ablation – this procedure aims to block the abnormal parts of a heart’s electrical rhythm. These techniques are used when medicines or cardioversion have not been successful.8
References
- Sign Against Stroke. Understanding Your Treatment Options. [Internet] [Cited 2020 Oct 22] Available from: https://en.signagainststroke.com/take-action-against-stroke/understanding-your-treatment-options Sign Against Stroke. Understanding Your Treatment Options. [Internet] [Cited 2020 Oct 22] Available from: https://en.signagainststroke.com/take-action-against-stroke/understanding-your-treatment-options Return to content
- Warfarin 1 mg Tablets - Summary of Product Characteristics (SPC) - (eMC) [Internet]. [cited 2020 Oct 23]. Available from: https://www.medicines.org.uk/emc/ product/2803/smpc Warfarin 1 mg Tablets - Summary of Product Characteristics (SPC) - (eMC) [Internet]. [cited 2020 Oct 23]. Available from: https://www.medicines.org.uk/emc/ product/2803/smpc Return to content
- Choices NHS. Anticoagulant medicines – NHS Choices [Internet] [cited 2020 Oct 23]. Available from: http://www.nhs.uk/conditions/Anticoagulant-medicines/Pages/Introduction.aspx Choices NHS. Anticoagulant medicines – NHS Choices [Internet] [cited 2020 Oct 23]. Available from: http://www.nhs.uk/conditions/Anticoagulant-medicines/Pages/Introduction.aspx Return to content
- NHS choices. Stroke Treatment. [Internet] [cited on 2020 Oct 23]. Available from: https://www.nhs.uk/Conditions/Stroke/Pages/treatment.aspx NHS choices. Stroke Treatment. [Internet] [cited on 2020 Oct 23]. Available from: https://www.nhs.uk/Conditions/Stroke/Pages/treatment.aspx Return to content
- The Task Force for the management of atrial fibrillation of the European Society of Cardiology (ESC). 2020 ESC Guidelines for the management of atrial fibrillation developed in collaboration with EACTS. Eur Heart J. 2020 Aug; doi: 10.1093/eurheartj/ehaa612. Return to content
- American Stroke Association. Types of Stroke [Internet] [Cited on 2020 Oct 22]. Available from: http://www.strokeassociation.org/STROKEORG/AboutStroke/TypesofStroke/Types-of-Stroke_UCM_308531_SubHomePage.jsp American Stroke Association. Types of Stroke [Internet] [Cited on 2020 Oct 22]. Available from: http://www.strokeassociation.org/STROKEORG/AboutStroke/TypesofStroke/Types-of-Stroke_UCM_308531_SubHomePage.jsp Return to content
- StopAfib.org [Internet] [cited on 2020 Oct 23]. Available from: http://www.stopafib.org/rate-control.cfm StopAfib.org [Internet] [cited on 2020 Oct 23]. Available from: http://www.stopafib.org/rate-control.cfm Return to content
- NHS Choices. Treating atrial fibrillation [Internet] [cited on 2020 Oct 23]. Available from: https://www.nhs.uk/Conditions/Atrial-fibrillation/Pages/Treatment.aspx NHS Choices. Treating atrial fibrillation [Internet] [cited on 2020 Oct 23]. Available from: https://www.nhs.uk/Conditions/Atrial-fibrillation/Pages/Treatment.aspx Return to content
