A stroke occurs when the blood supply to part of the brain is interrupted or reduced, depriving brain tissue of oxygen and nutrients. This can be due to a blocked artery (ischemic stroke) or the leaking or bursting of a blood vessel (hemorrhagic stroke). Strokes are a leading cause of death and disability worldwide. However, some drugs can help prevent strokes from occurring in the first place.
Blood Thinners
Blood thinners are medications that prevent clots from forming in the blood. Blood clots can travel to the brain and cause an ischemic stroke by blocking blood flow. Common blood thinners used to prevent strokes include:
Anticoagulants
– Warfarin (Coumadin): Warfarin is an oral anticoagulant that prevents clot formation by blocking the activity of vitamin K. It is effective for preventing clots in people with atrial fibrillation, prosthetic heart valves, and other conditions. Regular monitoring of blood levels is required.
– Dabigatran (Pradaxa), rivaroxaban (Xarelto), apixaban (Eliquis): These newer oral anticoagulants directly inhibit thrombin or factor Xa, clotting factors involved in blood clot formation. They have more predictable effects than warfarin and do not require as much monitoring.
– Heparin and low-molecular weight heparins: Heparin is administered intravenously or by injection and is faster-acting than warfarin. The low-molecular weight heparins, like enoxaparin (Lovenox), are injected and are easier to use than heparin.
Antiplatelets
– Aspirin: At low doses, aspirin prevents clot formation by interfering with platelet function. It is commonly recommended for people at high risk of ischemic stroke.
– Clopidogrel (Plavix), prasugrel (Effient), ticagrelor (Brilinta): These platelet aggregation inhibitors are oral medications often used in combination with aspirin after placement of stents.
– Dipyridamole (Persantine), cilostazol (Pletal): These platelet inhibitors are alternatives when aspirin cannot be used.
Cholesterol Medications
High cholesterol, especially LDL (“bad”) cholesterol, leads to the buildup of fatty deposits called plaque in the arteries. This atherosclerosis narrows arteries and increases the risk of an ischemic stroke. Cholesterol-lowering medications like statins reduce this risk.
– Statins: Statins like atorvastatin (Lipitor), rosuvastatin (Crestor), and simvastatin (Zocor) lower LDL cholesterol by reducing cholesterol production in the liver. They also stabilize plaque.
– Other cholesterol medications: Ezetimibe (Zetia), niacin, fibrates, and bile acid sequestrants are sometimes used in combination with statins or if statins are not tolerated.
Blood Pressure Medications
High blood pressure is a major risk factor for all types of stroke. It damages arteries and makes them prone to plaque buildup. Medications to control blood pressure help prevent ischemic and hemorrhagic strokes.
ACE inhibitors and ARBs
– ACE inhibitors like lisinopril (Prinivil, Zestril), ramipril (Altace), and enalapril (Vasotec) block the production of angiotensin II, a hormone that narrows blood vessels.
– Angiotensin receptor blockers (ARBs) like losartan (Cozaar) and valsartan (Diovan) block the effects of angiotensin II.
Diuretics
– Diuretics like hydrochlorothiazide, chlorthalidone, and furosemide (Lasix) lower blood pressure by helping the body eliminate salt and water through urine.
Beta blockers
– Beta blockers like atenolol (Tenormin), metoprolol (Lopressor), and carvedilol (Coreg) reduce blood pressure by blocking epinephrine receptors and slowing the heart rate.
Calcium channel blockers
– Calcium channel blockers like amlodipine (Norvasc), diltiazem (Cardizem), and nifedipine (Procardia) relax blood vessels by affecting calcium transport.
Diabetes Medications
Diabetes raises stroke risk by promoting atherosclerosis. It also causes high blood pressure and other cardiovascular problems. Good control of diabetes with medications can lower stroke risk.
Oral medications
– Metformin (Glucophage) reduces glucose production by the liver and improves insulin sensitivity. It does not cause low blood sugar.
– Sulfonylureas like glipizide (Glucotrol) and glyburide (Micronase) prompt the pancreas to release more insulin but can cause hypoglycemia.
– Newer drugs like DPP-4 inhibitors (Januvia, Onglyza) and GLP-1 agonists (Victoza, Ozempic) reduce blood sugar in other ways that lower hypoglycemia risk.
Insulin therapy
– For advanced diabetes, injectable insulin is required. Long-acting insulins like glargine (Lantus) provide baseline coverage, while short-acting insulins like lispro (Humalog) cover meals.
Lifestyle Changes
In addition to medications, important lifestyle measures can help prevent strokes:
– Quit smoking and avoid secondhand smoke, as smoking damages blood vessels.
– Exercise regularly to lower blood pressure, cholesterol, and diabetes risk.
– Eat a healthy diet low in sodium, fat, and refined sugars. Get plenty of fruits, vegetables, and whole grains.
– Limit alcohol intake, as heavy drinking raises blood pressure.
– Achieve and maintain a healthy weight. Obesity adds to various stroke risk factors.
– Manage stress, as chronic stress may contribute to stroke risk. Try meditation, yoga, or other relaxation techniques.
Conclusion
Strokes can often be prevented through the use of appropriate medications that reduce key risk factors like abnormal blood clotting, high blood pressure, high cholesterol, and diabetes. Blood thinners, antihypertensives, statins, and antidiabetic drugs are commonly used, along with lifestyle modifications. However, work closely with your doctor to determine the right stroke prevention plan for your individual health profile and risks. Consistent monitoring and follow-up are essential for ensuring the medications are optimally effective and safe.