After a stroke, medicines are often needed to treat the immediate event and to lower the chance of another stroke. These drugs work in different ways, such as breaking up clots, thinning the blood, lowering cholesterol or controlling blood pressure. The right treatment depends on the type of stroke, a person’s health history and how their body responds over time. Medicines are usually combined with healthy lifestyle changes and, in some cases, procedures for the best protection.  

Your care plan is personal, and your doctor will help explain your options, track progress and adjust treatment as needed. 

Types of medicines 

• Clot-busters (thrombolytics): These may be given right away for some ischemic strokes, within a limited time window, to help dissolve a new clot. An example of this is alteplase (Activase). 

• Antiplatelet medicines (“blood thinners”): These help stop new clots from forming. Examples include aspirin (Bayer Aspirin), clopidogrel (Plavix) and aspirin/dipyridamole (Aggrenox). 

• Anticoagulants (“blood thinners”): These reduce stroke risk when blood clots are linked to an irregular heartbeat (atrial fibrillation) or other conditions. Examples include apixaban (Eliquis), rivaroxaban (Xarelto), dabigatran (Pradaxa) and warfarin (Coumadin). 

• Cholesterol-lowering medicines (statins and others): These help keep arteries healthy. Examples include atorvastatin (Lipitor) and rosuvastatin (Crestor). 

• Blood-pressure medicines: Many types can protect the brain by lowering blood pressure. Examples include lisinopril (Zestril), amlodipine (Norvasc) and metoprolol (Lopressor). 

How doctors choose a medicine 

The choice of medicine depends on the type of stroke (ischemic or hemorrhagic), when symptoms started, your age, other health problems and the medicines you already take. For example, if you arrive within a short time window and it is an ischemic stroke, a clot-buster like alteplase (Activase) may be considered. If you have atrial fibrillation, an anticoagulant such as apixaban (Eliquis) may be recommended. In many cases, medicines are combined—for example, an antiplatelet plus a statin. 

Monitoring and follow-up 

Your doctor may check your blood pressure, cholesterol and symptoms during follow-up visits. Some medicines require blood tests. For example, warfarin (Coumadin) needs regular INR checks to confirm the dose is safe and effective. You may also be asked to monitor your blood pressure at home and to report any new symptoms such as unusual bleeding, headaches, weakness, speech trouble or vision changes right away. 

Adjusting therapy over time 

Your treatment plan may change over time. If you experience side effects, your doctor may lower the dose or switch medicines. If your risk remains high, another medicine may be added—for example, increasing statin strength or changing your blood thinner. If bleeding or another complication occurs, therapy may be adjusted or paused. 

Working together with lifestyle changes 

Medicines work best when combined with healthy habits. Aim for a heart-healthy diet, regular activity as advised, no smoking, limited alcohol, good sleep and stress control. It is also important to treat other conditions, such as diabetes or sleep apnea, if present. Some people may also need procedures, such as carotid artery treatment or stents, along with medicines. Your care team will tailor the plan to your needs. 

Precautions and safety 

All medicines carry risks, and not all are safe for every person. A few examples include: 

• Bleeding risk: Blood thinners can raise the chance of bleeding. Call your doctor right away if you notice unusual bleeding, black stools or easy bruising. 

• Pregnancy and organ health: Some medicines are not safe during pregnancy or if you have serious kidney or liver disease. 

• Drug interactions: Certain antibiotics or over-the-counter pain relievers, such as ibuprofen (Advil, Motrin), can interact with blood thinners and increase bleeding risk. 

• Side effects: Some cholesterol or blood pressure medicines may cause muscle pain, cough or dizziness. Tell your doctor if you notice new or bothersome symptoms. 

Always tell your care team about allergies, health conditions and all the medicines or supplements you take. This list does not cover every possible risk. It is also important to take medicines exactly as prescribed. Skipping doses or stopping suddenly can raise your risk for another stroke. If cost, side effects or remembering doses is hard, talk to your doctor—there are often solutions.