Medications' Role In Preventing Strokes: An Exploration

Medication can be used to prevent a stroke or to prevent a second stroke after a person has already had one. The type of medication used depends on the type of stroke. Ischemic strokes are caused by a clot in an artery that supplies blood to the brain, and Hemorrhagic strokes happen when there is bleeding inside the brain as a result of a ruptured blood vessel. Transient ischemic attacks (TIAs) are a warning that you could have a stroke later. High blood pressure, also called hypertension, is a top cause of both types of stroke, so medication is often used to bring these readings down. Diuretics, ACE inhibitors, beta-blockers, calcium channel blockers, and angiotensin II receptor blockers are all used to lower blood pressure. If you've had an ischemic stroke, you're likely to take a drug to prevent future blood clots. Anticoagulants and antiplatelets are used to prevent clots from forming. Statins are used to lower the risk of a stroke by reducing cholesterol and other fats in the blood.

Blood pressure medication

There are several types of blood pressure-lowering drugs, and doctors will work with patients to find the best drug or combination of drugs for them. Diuretics, also known as water pills, are one such treatment. They help the body get rid of excess salt and fluids, but they can lower potassium levels, which may cause weakness, leg cramps, and fatigue. ACE inhibitors are another type of blood pressure drug, which work by relaxing and widening blood vessels, allowing blood to flow more easily. Beta-blockers are a type of drug that stops the effects of adrenaline, so the heart beats with less speed and pressure. Calcium channel blockers help blood vessels relax and open up by blocking calcium from entering the cells in the heart and blood vessels. They also slow the heart rate, which lowers blood pressure. Angiotensin II receptor blockers make it easier for the heart to pump by blocking a chemical that narrows blood vessels.

Clot-busting medication

A stroke occurs when blood cannot reach all parts of the brain, resulting in potential brain injury. Ischemic strokes are caused by a clot in an artery that supplies blood to the brain, while haemorrhagic strokes happen when a blood vessel in the brain ruptures and bleeds.

TPA has been shown to reduce the severity of a stroke and reverse some of its effects, aiding in quicker recovery. However, it is not suitable for everyone. Patients with a history of bleeding problems, recent surgery, trauma, uncontrolled high blood pressure, or recent head injury may not be able to receive tPA due to the increased risk of bleeding.

There is also ongoing research into newer clot-busting medications, such as tenecteplase, which has shown promising results in reducing the risk of serious bleeding in the brain compared to the current standard medication, alteplase. Tenecteplase is administered as a single injection into a blocked blood vessel, making it a potentially more convenient treatment option.

Blood-thinning medication

Antiplatelet Drugs

Antiplatelet drugs prevent platelets from sticking together and forming blood clots. The most common antiplatelet drug is acetylsalicylic acid (ASA), also known as aspirin. Other antiplatelet drugs include clopidogrel, dipyridamole, and ticlopidine. If you are taking an antiplatelet drug, you are at a higher risk of bleeding more than usual if you injure yourself.

Anticoagulants

Anticoagulants prevent new blood clots from forming and keep existing blood clots from getting larger. They are usually prescribed for people with an irregular heartbeat (atrial fibrillation), which can cause blood clots to travel from the heart to the brain. Anticoagulants are commonly used in people who have had a stroke to help prevent another one. Anticoagulant medications include:

• Heparin – given by needle at the hospital and often used after a stroke to prevent clotting. It can only be taken for a few days.
• Warfarin – a pill that can be taken for a longer period of time. It must be taken for several days before it takes effect.

Side Effects and Precautions

Both types of blood thinners can increase your risk of bleeding. Therefore, it is important to tell your doctor and dentist that you are taking a blood thinner before any medical treatments or surgery. Additionally, certain foods may interfere with the absorption and effectiveness of anticoagulants, such as grapefruit and grapefruit juice, and cruciferous vegetables like broccoli and cauliflower.

Cholesterol-lowering medication

Statins are the most common type of medication used to control cholesterol levels. They are highly effective in reducing the risk of ischaemic stroke, regardless of an individual's cholesterol level. In fact, higher doses of statins are often prescribed even for people with normal cholesterol levels. Statins have been used since the late 1980s and have helped countless people control their cholesterol and prevent strokes.

While statins are generally well-tolerated, they do have some side effects, so they may not be suitable for everyone. However, a new class of cholesterol-lowering drugs called PCSK9 inhibitors has been introduced. These drugs can be used in conjunction with statins to further lower cholesterol levels and reduce the risk of stroke. PCSK9 inhibitors are particularly beneficial for individuals who cannot take statins due to side effects or other medical conditions.

In addition to medication, lifestyle changes play a crucial role in stroke prevention. This includes eating a healthy diet, maintaining a healthy weight, exercising regularly, avoiding smoking, and limiting alcohol consumption. By combining cholesterol-lowering medication with healthy lifestyle choices, individuals can significantly reduce their risk of stroke.

Antidepressants

SSRIs have long been considered safer than older antidepressants, which may cause more side effects. They work by blocking the reuptake of serotonin, a brain chemical that affects mood and emotional responses. However, they have been found to slow down the rate of blood clot formation, which may explain the link to stroke.

A 2012 study found that people taking SSRIs were 50% more likely to have an intracranial hemorrhage than those not taking antidepressants and had a 40% elevated risk of having an intracerebral hemorrhage. These are types of hemorrhagic strokes, which occur when a blood vessel in the brain becomes weak and bursts open, causing blood to leak into the brain. However, the study author, Dr. Daniel G. Hackam, emphasised that "because these types of strokes are very rare, the actual increased risk for the average person is very low".

Another study, published in the American Heart Association journal Stroke, found that SSRI medication carried a 45% greater risk of hemorrhagic stroke in young adults with PTSD. The lead author, Allison Gaffey, suggested that:

> Health care providers might consider prescribing other classes of antidepressants, such as SNRIs, or other treatments, such as cognitive behavior therapies, among younger patients who have other risk factors for hemorrhage.

While antidepressants may increase the risk of stroke recurrence, particularly ischemic stroke, they have also been found to have a positive effect on stroke management by reducing the incidence of post-stroke depression and improving functional recovery. A Cochrane review concluded that SSRIs might improve recovery after a stroke, although there was heterogeneity between published trials and methodological limitations.

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