Medication and surgery
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 to reduce blood pressure
- Antiplatelet agents
- Anticoagulants which both prevent blood clots from forming or growing
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 drugs from which your doctor can choose. If you have already had a stroke or a TIA, the use of the blood pressure lowering drug perindopril in combination with indapamide has been shown to reduce the chance of having a further stroke significantly.
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 drugs 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.
Anticoagulant drugs interfere with the production of certain blood components that are necessary for the formation of blood clots. The most common 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).
There are newer medications for people with atrial fibrillation that may also be available. Your doctor can advise the most appropriate medication for you.
People are urged not to stop taking their cholesterol-lowering medication without consulting their doctor. Chair of the National Stroke Foundation Clinical Council, Professor Richard Lindley, says it is vitally important for people to stay on medication prescribed by their doctors.
“If you have already had a cardiovascular event such as a heart attack or stroke, you are at elevated risk of having another one,” he said.
“Suddenly stopping your medication will leave you vulnerable to a further stroke or heart attack and this could prove fatal. It’s unwise and not worth the risk.
“No one should stop taking their prescribed medication, unless advised by their doctor. “
Professor Lindley answers your questions in this short video
Find out the facts about statins by downloading our Anticoagulant fact sheet
Or read more on the National Prescribing Service website.
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 buildup 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.