Stress Management

Stroke

Conventional Treatments for Stroke

The type of stroke therapy a patient receives depends upon the stage of disease.

Generally there are three treatment stages for stroke:

Prevention

Therapies to prevent a first or recurrent stroke are based on treating an individual's underlying risk factors for stroke, such as hypertension, atrial fibrillation, and diabetes, or preventing the widespread formation of blood clots that can cause ischemic stroke in everyone, whether or not risk factors are present.

Therapy During/Immediately After a Stroke

Stroke victims are immediately admitted to the hospital and, in many cases, will be given medication to prevent further brain damage. Normally, clot strokes are treated with an anticoagulant drug such as heparin.

If a doctor administers a clot-dissolving drug within 3 hours of an ischemic stroke, normal blood flow can often be restored, and the risk of death or permanent disability drops by about 30 percent. There are also brain-saving drugs that reduce the number of brain cells killed by the stroke and help minimize disability.

Emergency surgery might also be required to drain blood that has hemorrhaged into the brain and perhaps to clip a ruptured artery or aneurysm-blocking off the vessel to halt further bleeding. 

Post-stroke Rehabilitation

Once past the critical phase, a stroke patient remains hospitalized until stable.

Upon release, patient and doctor carefully review necessary steps for recovery and prevention of future strokes. Advice will likely involve diet and lifestyle changes, ongoing drug treatment, rehabilitative therapy, and possible surgery for critical arterial narrowing. The purpose of post-stroke rehabilitation is to overcome disabilities that result from stroke damage.

See Also: Management of Primary Stroke Risk Factors

Therapies for stroke can be classified under:

Medications or Drug Therapy

Surgery

Rehabilitation - Lifestyle changes

Medications

Medication or drug therapy is the most common treatment for stroke. The most popular classes of drugs used to prevent or treat stroke are:

Antithrombotics (anti-platelet agents and anticoagulants)

Thrombolytics

Neuroprotective agents

Antithrombotics

Antithrombotics prevent the formation of blood clots that can become lodged in a cerebral artery and cause strokes. Antiplatelet drugs prevent clotting by decreasing the activity of platelets, blood cells that contribute to the clotting property of blood. These drugs reduce the risk of blood-clot formation, thus reducing the risk of ischemic stroke. In the context of stroke, physicians prescribe antiplatelet drugs mainly for prevention. 

The most widely known and used antiplatelet drug is aspirin. Other antiplatelet drugs include clopidogrel and ticlopidine.

See Also: Use of Antiplatelet Agents after Transient Ischemic Attack (TIA) and Stroke

Anticoagulants

Anticoagulants reduce stroke risk by reducing the clotting property of the blood.

The most commonly used anticoagulants include warfarin (also known as Coumadin ) and heparin.

One clinical test found that, although aspirin is an effective therapy for the prevention of a second stroke in most patients with atrial fibrillation, some patients with additional risk factors do better on warfarin therapy.

Another study showed that heparin anticoagulants are not generally effective in preventing recurrent stroke or improving outcome.

Thrombolytic Agents

Thrombolytic agents are used to treat an ongoing, acute ischemic stroke caused by an artery blockage. These drugs halt the stroke by dissolving the blood clot that is blocking blood flow to the brain.

Recombinant tissue plasminogen activator (rt-PA) is a genetically engineered form of t-PA, a thombolytic substance made naturally by the body. It can be effective if given intravenously within 3 hours of stroke symptom onset, but it should be used only after a physician has confirmed that the patient has suffered an ischemic stroke. 

Thrombolytic agents can increase bleeding and therefore must be used only after careful patient screening.

Neuroprotectants

Neuroprotectants are medications that protect the brain from secondary injury caused by stroke. There are several different classes of neuroprotectants that show promise for future stroke therapy, including calcium antagonists, glutamate antagonists, opiate antagonists, antioxidants, apoptosis inhibitors, and many others. 

One of the calcium antagonists, nimodipine, also called a calcium channel blocker, has been shown to decrease the risk of the neurological damage that results from subarachnoid hemorrhage. Calcium channel blockers, such as nimodipine, act by reducing the risk of cerebral vasospasm, a dangerous side effect of subarachnoid hemorrhage in which the blood vessels in the subarachnoid space constrict erratically, cutting off blood flow.

Source: National Institutes of Health

Caution: If you suspect a stroke, seek emergency medical treatment immediately. Time is of essence.

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