Antiplatelets

Stroke MedicationsPlatelets are blood cells that help the blood to clot and prevent bleeding. When the body has a cut, scratch, bruise or bleed, platelets go into action and begin to work. These platelet cells need thromoxane A2 and adenosine; vitamin K specific clotting factors (chemicals produced by the body) to make them stick together. These chemicals are essentially the glue that holds the blocks together to make the clot. However, in patients who have had a TIA or stroke, the blocks don’t need to stick together as much because this causes the blood to be too thick (like adding flour to milk when making a cake batter) and possibly form a clot that can’t fit through the vessels.

Doctors often place stroke and TIA patients on blood thinners to decrease the possibility of the body forming another clot in the blood, which may lead to another stroke and TIA. Below is information on specific types of antiplatelets used for stroke prevention.

Aspirin (acetylsalicylic acid, ASA)

Aspirin

Besides relieving pain, fever and inflammation, aspirin has many other uses. Aspirin is also used as an antiplatelet/platelet aggregation inhibitor (to keep your blood from sticking together) in patients who have had a TIA or stroke. It can also reduce the risk of having another TIA or stroke. Different doses are used for this purpose, ranging from 50mg to 325mg/day, depending on the patient’s condition and the doctor’s decision.

The idea that “if one is good for me, two or three must be better” is wrong. Do not adjust your dose without first talking to the pharmacist or doctor that dispensed or prescribed the medication. The dose is not the same for everyone. The usual dose for stroke/TIA prevention is 30-325mg a day. Take the medication according to the prescription. Even though you may be taking an 81mg (baby aspirin) a day, someone else who had a stroke may be taking 325mg of aspirin a day or may be on a different medicine for stroke prevention. Don’t rely on what you hear from other stroke patients, and don’t take more or less of the drug without first talking to the doctor who prescribed it.

Since aspirin can irritate the stomach, it is best to take it with food or a full glass of water or milk to help avoid or lessen possible stomach problems.

Aspirin will help prevent platelets from making the blood too thick, thereby reducing the risk of a clot. Taking aspirin regularly will lessen your body’s ability to stop bleeding when you are cut, scratched, or bruised. Your doctor wants the aspirin to thin the blood (decrease the body’s ability to form a clot) just enough to help prevent a future TIA or stroke. Watch for blood in the urine, stools, or around the gums when eating and brushing teeth; bleeding from the nose; or easy bruising. If you notice abnormal or excessive bleeding, let your pharmacist and doctor know, and talk with them before you change or take any new medicines.

Abdominal (stomach area) pain that will not go away and ringing in the ears are other signs that there might be a problem with the medication. Let the pharmacist or doctor know if you have any of these warning signs.

Talk with your pharmacist or doctor before taking any other aspirin products, anti-inflammatory agents (Aleve, Naprosyn, Ibuprofen, etc…) or any other medications.

Clopidogrel (Plavix®)

Plavix

Clopidogrel (Plavix®) is an antiplatelet/platelet aggregation inhibitor drug that is used to help prevent another stroke. It does this by decreasing the blood’s ability to clot. This means that when you get a cut or scratch it will take a little longer to stop bleeding. Watch for blood in the urine, blood in the stools, bleeding around the gums when eating and brushing teeth, bleeding from the nose, or bruising easily. If you notice abnormal or excessive bleeding, let your pharmacist and doctor know, and talk with them before you change or take any new medicines.

You will take one 75mg tablet once a day in the morning (can be taken with or without food), or when and how your pharmacist and doctor tell you. Do not adjust the dose without first talking to the pharmacist or doctor that dispensed or prescribed the mediation, and be sure to talk with your pharmacist or doctor before taking any other medications.

Dipyridamole (Aggrenox®, Persantine® and others)

Aggrenox

Aggrenox is the combination of aspirin (25mg) and extended release dipyridamole (200mg), two antiplatelet/platelet aggregation inhibitors. Each of these medications work together in similar ways but on separate chemicals in the blood to help prevent a future TIA or stroke. Do not adjust the dose without first talking to the pharmacist or doctor who dispensed or prescribed the medication. The aspirin portion of the combination works in the same way as above, but the dirpyridamole helps prevent platelets, blood cells and the vessels from using adenosine (another chemical that helps the bricks and glue form a clot). Dipyridamole also has the potential to vasodilate the vessels that carry the blood to allow more blood and particles to flow through (like a water hose expanding in the summer sun).

The combination capsule Aggrenox® (aspirin and dipyridamole) cannot be substituted by taking each drug separately. Taking the two separately does not have the desired effect as the combination capsule does.

Take one capsule in the morning (with or without food) and take one capsule in the evening (with or without food) for a total of two capsules a day. Swallow the capsule. Do not chew it or crush it. It must be swallowed whole. Take the medication the way the pharmacist and doctor told you.

Many patients starting on Aggrenox® develop a severe headache due to the vessels in the brain vasodialating (expanding). This headache tends to decrease and go away as the body gets used to the medicine. In the meantime, use an over-the-counter pain reliever and call the pharmacist or doctor to inform them of the headache.

The combination of aspirin and dipyridamole is a stronger blood thinner than either drug alone. So, watch for blood in the urine, blood in the stools, bleeding around the gums when eating and brushing teeth, bleeding from the nose, or bruising easily. If you notice abnormal or excessive bleeding, let your pharmacist and doctor know, and talk with them before you change or take any new medicines.

Talk with your pharmacist or doctor before taking any other aspirin products, anti-inflammatory agents (Aleve, Naprosyn, Ibuprofen, etc…) or any other medications.

Ticlopidine (Ticlid®)

Ticlid

Ticlid® is used to help prevent another stroke. You will take a 250mg tablet two times a day (one in the morning and one in the evening) with food. Take the medicines like the pharmacist and doctor told you, and do not adjust the dose without first talking to the pharmacist or doctor that dispensed or prescribed the medications. Be especially observant of any excessive bleeding such as blood in the urine, blood in the stools, bleeding around the gums when eating and brushing teeth, bleeding from the nose, or bruising easily. If you notice abnormal or excessive bleeding, let your pharmacist and doctor know, and talk with them before you change or take any new medicines.

You will have to have lab work done every two weeks for the first three months of treatment to check your blood levels. Talk with your pharmacist or doctor before taking any other aspirin products, anti-inflammatory agents (Aleve, Naprosyn, Ibuprofen, etc…) or any other medications.