What are the drugs used to treat stroke patients?

Drugs for Initial Treatment of Ischemic Stroke

Intravenous Thrombolytics. Clot-busting, or thrombolytic, drugs, normally used for breaking up existing clots in people who have had heart attacks, are now administered intravenously for ischemic (not hemorrhagic) stroke. The standard thrombolytic drug used for stroke is t-PA or alteplase (Activase). Streptokinase is also sometimes used and others are under investigation. The following steps are critical before administering these agents.

• Before t-PA is given, a CT scan must also first confirm that the Stroke is not hemorrhagic.
  
• Thrombolytics must be administered within three hours of a stroke (but not after that period) to have any effect. Unfortunately, most stroke patients arrive at the hospital more than three hours after an attack and therefore are not eligible for treatment. This delay is the primary reason why only 1% to 2% of stroke patients are receiving these agents.
  

T-PA itself carries a risk for hemorrhage and they may not be appropriate for patients with existing risk factors for bleeding. The drug may be appropriate in more patients than previously thought, however, including older people, those with a history of stroke, and those with high blood pressure. More research is needed to confirm this. Thrombolytics are used less frequently than they should be in certain groups, particularly African Americans.

Intra-Arterial t-PA . Researchers are investigating a t-PA agents injected directly into an artery in the brain. Early studies suggest this approach may allow effective treatment up to six hours after a stroke and improve recovery in more patients. The risk for bleeding is increased, however.

Ancrod. Ancrod is an agent derived from the venom of a pit viper snake that reduces the amount of a blood clotting factor called fibrinogen. Although it is not actually a clot-busting drug, some experts believe it might be a possible alternative to thrombolytics. Studies are reporting less disability in patients who are given ancrod within three hours of the stroke. (It is not clear yet whether the agent improves survival.) As with all anti-clotting agents, there is a slightly higher risk for hemorrhage.

Anti-Clotting Medications

Medications that prevent blood from coagulating or clotting have been used for years in people at risk for a recurring stroke. They may also be warranted in some patients at high-risk for a first stroke. A major analysis of 17 trials reported that in patients with a history of TIA or stroke antiplatelet treatment reduced the chances of a second stroke, heart attack, and related deaths by 22%. These benefits were evident in men and women of any age, including those with and without hypertension or diabetes. In general, they are initiated within 48 hours of an ischemic stroke and continued as maintenance.