Medication for Stroke

NYU Langone physicians often prescribe medication as an emergency treatment for people who have had an ischemic stroke or transient ischemic attack, in which an artery that supplies oxygen-rich blood to the brain becomes blocked.

If a clot has formed in one of the arteries supplying blood to the brain, a clot-busting medication called tissue plasminogen activator (tPA) can be administered through a vein with intravenous (IV) infusion. In order to work, this medicine must be given within four hours of the onset of symptoms. 

People whose time of stroke onset cannot be established with certainty, those with who take blood thinners, and people who have recently had surgery may not be eligible for tPA. Only carefully selected people with stroke are considered candidates for tPA.

Sometimes, tPA can be delivered to the site of a clot. Doctors may insert a thin, flexible tube called a catheter through an artery in the groin and thread it to the brain in a procedure called an angiogram. Then they release tPA into the area where the stroke is occurring. This minimally invasive technique has been found to be more effective than intravenous administration of the drug. Side effects include nausea, vomiting, and dizziness, but also can include hemorrhage.

A doctor may also prescribe an antiplatelet medicine, such as aspirin, dipyridamole, clopidogrel, or ticlopidine. This helps prevent platelets—parts of the blood that help the blood clot—from clumping together to form blood clots. Side effects include nausea, upset stomach, and diarrhea. 

Your doctor may also recommend a medication called an anticoagulant, or blood thinner. This medication, which includes warfarin and heparin, can stop blood clots from growing and prevent new ones from forming. Side effects include abdominal pain, dizziness, and headaches.

Your doctor decides which one of these medications to prescribe based on your medical history and risk factors for a stroke. Anticoagulants are considered more aggressive than antiplatelets. Doctors may recommend anticoagulants for people who are at high risk of a stroke or those with atrial fibrillation, an irregular heartbeat that increases the chance of developing blood clots.

If you are taking antiplatelet medicines or blood thinners and have a hemorrhagic stroke, your doctor may advise you to stop taking them. If high blood pressure is causing bleeding in the brain, a doctor may prescribe medication to lower blood pressure and help prevent additional bleeding.