The New Jersey Comprehensive Stroke Center at University Hospital
Preventive Drug Treatments
Antithrombotic medications, often broadly referred to as blood thinners, can play an important role in preventing ischemic stroke and its recurrence. When blood clots block the flow of blood vessels in the brain, they can lead to a stroke. Antithrombotic medications are used to prevent clot formation or to prevent a clot that has formed from enlarging. They cannot, however, dissolve clots that have already formed.
Antithrombotic drugs fall into two major categories: 1) Anticoagulants, which are inhibitors of clotting factor synthesis or activation, and 2) Antiplatelets, which are inhibitors of active platelets. These drugs are sometimes used in various combinations for the added efficacy of preventing stroke. Some of these medications are available in a tablet form and some are injectable. It is not uncommon to have increased bruising or bleeding while taking these medications, so caution should be used.
Oral Anticoagulant medications:
Anticoagulants inhibit the production of certain clotting factors in the liver and prevent their activation in the bloodstream. The most commonly used anticoagulant is warfarin (Coumadin®), but there are several newer FDA approved agents that are now available on the market, some of which are listed below:
- Dabigatran (Pradaxa®)
- Rivaroxaban (Xarelto®)
- Apixaban (Eliquis®)
- Edoxaban (Savaysa®)
Injectable Anticoagulant medications:
These medications block thrombin (a factor in the bloodstream required for clotting) from binding with platelets. They are administered subcutaneously or intravenously. Commonly used medications in this category are heparin and enoxaparin (Lovenox®).
Oral Antiplatelet medications:
Platelets are blood cells that are activated when there is an injury in the body. These cells help prevent bleeding by aiding in the formation of blood clots. The platelets will clump together (aggregate) to form this clot. Antiplatelet medications interfere with the platelet activation and aggregation so that clots are less likely to form in the body and within blood vessels.
There are multiple oral antiplatelet medications available. The most commonly used of these medications is Aspirin (acetylsalicylic acid, ASA), but there are several other drugs in this category, some of which are:
- Clopidogrel (Plavix®)
- Dipyridamole + Aspirin (Aggrenox®)
- Ticlopidine (Ticlid®)
- Prasugrel (Effient®)
- Ticagrelor (Brilinta®)