1 out of 5 stroke sufferers are at risk of a repeat stroke within 3 months . Therefore pre venting a repeat stroke is extremely important .
Medications for acute treatment (TPA)
A tissue plasminogen activator assists in disintegrating a blood clot and is administered in the event of myocardial infarction. This treatment can only be administered within the first 4.5 hours after the beginning of the stroke, after discounting the possibility of cerebral hemorrhage with a CT. The treatment requires hospitalization at a neurological ward and medical supervision. It reduces the chances of disability and handicap in people who have suffered a stroke.
Treatments for the prevention of blood clot formation and for reducing the risk of a stroke
Antiplatelet and anticoagulant therapy (“blood thinners”) assist in reducing the risk of a stroke by preventing blood coagulation. As part of the treatment program, the doctor will address other factors that can affect the treatment and its outcome, such as: blood pressure, high cholesterol, diabetes, earlier stroke, obesity, smoking, etc. Therefore he will adjust the treatment to suit the patient’s personal circumstances. If the medications make you feel unwell, you should contact your doctor to determine whether the treatments interfere with each other or if any reactions are occurring between drugs.
Vitamin K antagonists, such as Coumadin – Warfarin and Sintrom.
There are four essential coagulation factors (proteins) in the body that depend on vitamin K to permit the blood to coagulate. Vitamin K antagonists inhibit the formation of these factors in the body and thus prevent the formation of blood clots. Regular blood tests must be performed to ensure the medication is working and the dose is correct.
Catheterization for stroke prevention (watchman)
Intervention therapy employing a catheter to reduce the risk of stroke in patients suffering from non-valvular atrial fibrillation. Used in patients that cannot be treated with anticoagulants for various reasons. The technology permits blocking the passage of blood clots from the left atrial appendage (the area from where clots causing strokes are sent) by a special device – a watchman.
Direct thrombin inhibitors (DTI) such as Dabigatran – Pradaxa
The body’s blood coagulation system includes an enzyme called thrombin. The body produces this enzyme and uses it to promote clot formation. DTI medications inhibit the production of thrombin, thus preventing blood clot formation. The medication’s effect is predictable, preventing the need for monitoring it through regular blood tests such as INR. Prior to the treatment, a renal function evaluation must be performed. The medication is practically unaffected by food.
Factor Xa inhibitors (such as Rivaroxaban – Xarelto, Apixaban – Alcavis)
The body’s blood coagulation system includes the coagulant protein Xa. Medications that inhibit the protein’s production prevent the formation of blood clots and constitute a new generation of anticoagulants. The drugs’ effect is predictable, preventing the need for regular blood tests such as INR. The drug’s renal evacuation is relatively low, making it more suitable for older patients. The drugs are practically unaffected by food.
Antiplatelets (such as Aspirin, Clopidogrel and Plavix)
Platelets have an important role in blood coagulation. Antiplatelets inhibit the platelets’ function and thus prevent clot formation. Antiplatelets are administered to patients with atrial fibrillation that have low risk of stroke.
Statins are the main group of drugs used for lowering high cholesterol levels and reducing the risk of coronary heart disease. Statins are used to lower triglycerides, and can potentially increase good cholesterol levels. Although there are various kinds of statins, their operation mechanism is similar, and is based on inhibiting the effect of the enzyme (reductase) that contributes to the process of cholesterol production, which reduces the liver’s rate of cholesterol production and the levels of general cholesterol and bad cholesterol.
Medications for lowering blood pressure are divided into several groups
1. Calcium inhibitors, diuretics and alpha blockers
2. Beta blockers, converting enzyme inhibitors and angiotensin receptor blockers
Drugs have different effects person to person. The doctor prescribes the patient a drug that would balance his or her blood pressure with minimal side effects, taking into consideration the patient’s age, pulse, additional medical conditions, etc. Combining several drugs has been found to be more effective in lowering blood pressure compared to using just one. Therefore, if a drug does not deliver satisfactory results, the doctor sometimes recommends adding another one. Usually a drug from group 1 would be combined with a drug from group 2.
The results of the treatment are not immediate, so one must be patient with blood pressure measured regularly to diagnose whether the drug is bringing blood pressure down to the desired degree. It is important to note and report to the doctor any unusual phenomenon in the course of treatment. In any case, treatment should not be abruptly discontinued, as in certain drugs this can lead to deterioration. Therefore before discontinuation consult your doctor.
Tips for preventing bleeding
- When taking anticoagulants, one has a tendency to bleed more easily. If you bump your head or fall, call a doctor or medical center immediately, as internal bleeding can occur with no outside signs.
- Pay special attention when using knives, scissors or any other sharp object. If possible, usean electrical razor.
- Use a soft toothbrush and waxed dental floss. Do not use toothpicks.
- Before any visit to the dentist or oral hygienist, be sure to mention you are taking anticoagulants.
- When working in the garden or using sharp objects, be sure to wear gloves.
- If you suffer from warts, go to a clinic. Do not try to treat them yourself.
- Try to prevent falls – ensure the stairs and floors are not loaded with excessive objects that you can bump into, and wipe wet areas immediately to prevent slipping.