It is very important to seek emergency medical attention for stroke symptoms. If you are having an ischemic stroke, which is caused by a blood clot, you may be given medicines that get rid of the clot. If you are having a hemorrhagic stroke, which is caused by bleeding in the brain, you will not be given medicines.

If you are having an ischemic stroke, you may be able to receive tissue plasminogen activator (t-PA), a clot-dissolving medicine. This medicine is strongly recommended, but it is most effective if given within 3 hours of the onset of stroke symptoms.¹ If you receive t-PA within this 3-hour window, it may improve your recovery. Evidence shows that there may be some benefit in giving t-PA even beyond 3 hours.¹³ However, t-PA can be life-threatening because it can cause bleeding in the brain. It is not used to treat hemorrhagic stroke.

Blood clots cause most strokes, so medicines that prevent the formation of blood clots are used to prevent additional ischemic strokes. These medicines are usually given after the initial treatment for stroke. They are not recommended in the first 24 hours after t-PA has been given.¹ The two types of medicines used to prevent clotting are:

• Antiplatelet medicines, which prevent the smallest cells in blood (platelets) from sticking together. Aspirin is the antiplatelet medicine most commonly used to prevent strokes. Two large studies showed that taking aspirin within 48 hours of a stroke may reduce the chance of another stroke and prevent death.³ People who cannot take aspirin or who have transient ischemic attacks (TIAs) or a stroke while taking aspirin are sometimes given other antiplatelet medicines, such as clopidogrel (Plavix). Another medicine that can prevent ischemic stroke is Aggrenox, which is aspirin combined with extended-release dipyridamole. Aspirin is not recommended within the first 24 hours of giving t-PA.¹
• Anticoagulants, which prevent the production of proteins needed for blood to clot normally. Anticoagulants (particularly warfarin) are the best method of preventing blood clots that form in the heart because of atrial fibrillation, heart attack, heart valve problems, or heart failure. Anticoagulants are not given as emergency treatment for stroke. If you take warfarin (such as Coumadin), see:

  Eating a steady amount of vitamin K when you take warfarin (Coumadin).

For people with coronary artery disease, treatment with cholesterol-lowering drugs called statins can slow the development of atherosclerosis in the carotid arteries and may also reduce the chance of having a TIA or stroke. Studies have shown a reduced risk of stroke in people taking statins.^{9, 14} (For more information on statins, see the topic High Cholesterol.)

Medication Choices

Medicine used in the emergency treatment of stroke caused by a clot (ischemic stroke) includes tissue plasminogen activator (t-PA), a medicine that breaks up clots.