Stroke
Medication to prevent another stroke
Most people who have had a stroke are prescribed medication to reduce their risk of having another one. People who have recurrent Transient Ischaemic Attacks are also prescribed medication to reduce their risk of a stroke.
- medication to reduce blockages in arteries from blood clots - antiplatelets or anticoagulants
- medication to lower blood pressure - antihypertensives and
- medication to lower cholesterol levels - statins.
The type of medication taken will depend on the type of stroke (bleed or clot) and factors that might have contributed to causing it (e.g. have high blood pressure or high cholesterol).
A few people were not keen on the idea of taking medication, particularly if they had previously not had to take any. However, most people also said that they took the medication because it was important to avoid having another stroke. One person described their medication as 'a life saver'.
Taking medicines regularly
People realised the importance of taking their medication regularly. Whilst some said they found it easy to remember what medication they had to take and when, others needed a little help. One woman explained that whilst she had been in hospital they had been given more and more responsibility for remembering their medication which she found very helpful. She still found it difficult to remember and now writes down when she has taken her tablets and uses an alarm as a reminder.
One man said he was generally very good at taking his medication but took special care and made...
One man said he was generally very good at taking his medication but took special care and made...
I'm very good at remembering to do these things. I recognise that it's a case of life or death really, so it's pretty important that I get my pills. So I get my pills and when we go away, I take my good, a good stock of pills with me that if we're going away for 10 days, I'll have enough for 20 days and I keep them in a purse really of my own, which is a pill purse [laughs] if you like. So I'm very careful with my medication. If I'm going on an aeroplane, the medication stays with me. It doesn't go into the hold, where things might or might not get lost. They stay, it stays in my personal baggage, you know, so I'm very good that way.
In the hospital they were given more responsibility for remembering their medication. She now...
In the hospital they were given more responsibility for remembering their medication. She now...
And then gradually they took you through and the next stage was that they put the drugs in the drawer in your little unit beside your bed and that drawer was always kept locked and you put the key on the other side of the unit. And so every night they changed then to night time, so you had your meal in the evening and then you were put to bed and then you were told to take your, take your drugs. So you took the key, you opened the drawer, you took your little pots out and you took your drugs and you put the pots back in the drawer and you locked it and most, most of the time you went to sleep. But I did wonder how they knew that you'd taken the correct amount of pills every night. I mean, lots of people could have just gone to sleep and forgotten to take their pills and I stayed awake one night and it was quite in the early hours and the nurse came in, unlocked the drawer, took the pots of pills out, went away, brought them back later on and put them back in the drawer and locked the drawer, put the key back. And I worked out obviously they checked the pots to see how many pills were missing each night, so they knew whether you'd taken your pills or not. So that, that was really good and of course putting you in charge of your pills then makes you more independent so when the time comes for, for release and if you do perhaps live on your own, it's much easier for you to know what, what drugs you're taking, why you're taking them, you know, and you have to know exactly remember to take them.
Taking, taking drugs, I find remembering, I don't know if other people have this problem but I now take quite a lot of pills every day. In fact, I take about 20 pills a day, some of them are spaced out through the day and I find I can take my pills, I have a certain amount of pills that I take at breakfast time and I set those out the night before and I take another set of drugs at night before I go to bed and I set those out. But the ones that I take every, every 4 hours during the day, I find those really difficult and I don't know if anybody else will be in the same situation but it's really difficult to remember. If you're going out somewhere, you're in company or you go out to dinner or you go out with friends or whatever, you suddenly look at the clock and think, 'Oh my goodness, I should have taken those pills 2 hours ago' and of course you've forgotten all about it. So I find that really difficult. Writing it down helps during the day if you're at home. It really helps to write down that you took one at 10 o'clock and the next lot will be due 4 hours later, so you can write it on a piece of paper, put it in the kitchen, put it down wherever you are, so that you pass that piece of paper and it does remind you. If you're going out, I've found now, although it doesn't always work because it's difficult, I take a tiny little alarm clock and I take my pills and I turn the alarm on for 4 hours later and if I’m out somewhere, the alarm goes off and hopefully I’m going to take my tablets. So that is another way of getting round it but I do find that time is difficult taking tablets. That is a problem.
Several people had a special pill box with days of the week and times labelled, which they or a relative would fill at the beginning of each week. A few, older people, those who lived alone or those who had a specific problem with remembering to take their medication had their tablets provided in special blister packs marked with days of the week and times.
She is not always there to give her mum her tablets so the chemist came to visit and discussed...
She is not always there to give her mum her tablets so the chemist came to visit and discussed...
She does get tablets from the doctor, as I said the chemist came along and discussed all the tablets with us and she now gets them on a weekly basis in a bubble, which is excellent and you can see what day and if it's morning or if it's tea-time or, it's an excellent, I really think it's an excellent service. That's saved a lot of worries actually, the, you know, she's, if I hadn't the tablets laid out ready the carers are not supposed to do that so, and sometimes my brothers or my sister are not sure what tablets she gets, although it was written down, maybe couldn't find it or what have you, so that's been a wee worry as well, but this, bubble thing is just absolutely wonderful, thoroughly, thoroughly appreciating that.
A man explained that he uses a special pill box and is generally very good at remembering his medication but he forgot once and knew to discard those pills and start the next day fresh.
He uses a special pill box which his wife fills for him at the beginning of the week. He only...
He uses a special pill box which his wife fills for him at the beginning of the week. He only...
Oh yes. We've got a box and we set it up for the whole week, Monday, Tuesday, Wednesday, Thursday, Friday, Saturday, Sunday. And it's [my wife] that does it and it's a squa..., it's a, wee squares and there's one for the whole week, for a.m. and p.m. and you can't go wrong.
And have you ever forgotten to take any?
Yes, yes. We were, where was I? Oh, we were somewhere, we were out somewhere and came back and not often, you know, it was getting late and we just tidied up whatever we did and went straight to bed and next morning' I never took my pills. But it's only once, it's only once ever that I forgot. I didn't see any difference myself [laughs] I don't know what it would have done. I don't suppose missing once would do make any difference but I wouldn't tell the doctor [laughs].
So what did you do when you'd forgotten? Did you just not take them?
No, you just don't take them. No, no, you can't take them then. Just continue and start the next day afresh.
Treatment for high blood pressure (antihypertensives)
High blood pressure can lead to an increase risk of having a stroke. High blood pressure is linked to both strokes caused by a bleed (haemorrhage) or a clot. Many people we spoke to had been found to have high blood pressure and were prescribed medication to control it and to help prevent another stroke. However, a few, often younger people, had strokes which were not caused by high blood pressure.
There are several different types of medication which work slightly differently to control blood pressure (antihypertensives) including: ACE inhibitors,calcium channel-blockers, beta- blockers and thiazide diuretics (see information from Chest heart and Stroke Scotland: Living with High Blood Pressure). Some people were taking more than one type of medication to control their blood pressure. It was sometimes necessary for the doctor to try a number of different medications before they found the one that was most suitable or to change the medication if there was a change in blood pressure.
She explains that there are lots of different medications to control blood pressure and they have...
She explains that there are lots of different medications to control blood pressure and they have...
And you said you did have high blood pressure as well?
Well I didn't have high blood pressure before, it came as a shock to me when all of a sudden my blood pressure was going up and going down up and down and of course when I was seen at one of the out-patients in March, on 7th March 2005 the blood pressure was a up and one of the doctors said I think we ought to put you on blood pressure tablets. And so I went first on 2mgs and then because it was going up I was put on the 4mgs. And there are so many different types of blood pressure tablets you know and you as an individual you will find out which one suits you, you know but the one which was given to me seems to be working for me.
Which one was that?
It's the Coversil, I can't pronounce, it's the Coversil and there's another long name to it as well.
She explained that since her stroke she has had her blood pressure monitored and had her...
She explained that since her stroke she has had her blood pressure monitored and had her...
Most people said they had no side effects from the blood pressure medication. A few people who were taking a water tablet as part of their medication to control blood pressure said they needed the toilet more often. A couple of people felt that the blood pressure medication made them less responsive, one man worried that his driving would be affected so changed to taking his medication before a sleep in the afternoon.
Medication to prevent clots forming (antiplatelets or anticoagulants)
Those people whose stroke had been caused by a blood clot were prescribed medication which stop the platelets in the blood sticking together (antiplatelet drugs). The most commonly prescribed drug was aspirin. A few people were being prescribed aspirin plus another anti-clotting drug dipyridamole or clopidogrel, which together are more effective at preventing clots than either alone. One woman explained that she now takes a tablet that contains both aspirin and dipyridamole which she finds much easier to take although sometimes it is not available in the hospital.
She takes an anti clotting drug that contains both aspirin and dipyridamole which she finds much...
She takes an anti clotting drug that contains both aspirin and dipyridamole which she finds much...
Aspirin can sometimes cause problems with the stomach and a few people had been prescribed a drug to take that protects the stomach lining, such as lansoprazole. If the symptoms are very severe an alternative to aspirin called clopidrogrel can be prescribed.
People whose stroke had been caused by a clot from an irregular heartbeat (atrial fibrillation), a problem with a heart valve or sometimes a block to the carotid artery were prescribed the anticoagulant warfarin. Warfarin needs to be carefully monitored which means having regular blood tests. Often people have to take different amounts of warfarin, usually tablets of different colours, on different days. One man said he found this difficult.
He has to vary the amount of warfarin he takes on different days by taking pills of different...
He has to vary the amount of warfarin he takes on different days by taking pills of different...
Yes.
Medication.
Yeah
The'
The' oh
Warfarin?
Yes.
Mmm. And how has that been? Does it, do you have any side effects?
No.
No bruising or'
No.
'or bleeding?
No.
No. How about the blood tests?
Yes the' the'
Warfarin pills?
Yes'
You have different coloured ones?
Yes. I know (Illustrating confusion).
It is hard to remember which one?
Yes. Yes. Yes.
Are they different strengths?
Yes.
' to take?
Yes.
And do you have to vary them over'
Yes.
'different days?
Mm hmm.
Yeah. Sometimes you have to'
Yeah.
'you know, take 14'
Yeah.
'or 20 another day?
Yeah.
Is that difficult to remember?
Yes.
It is important when you are on warfarin that you eat regular meals and avoid too much alcohol. People had also been warned not to have too many foods which contain vitamin K because they interfere with the warfarin (spinach, brussel sprouts, cabbage, watercress, broccoli). One woman explained that she could eat these vegetables but not every day.
She explains that she has to limit the amount of green leafy vegetables that she eats as they can...
She explains that she has to limit the amount of green leafy vegetables that she eats as they can...
Broccoli, can't eat it and pak choi because can't eat it because the vegetables for warfarin.
Oh right.
Yeah. So spinach. I love spinach. I love broccoli and I love pak choi but a tiny bit, you know, all of it doesn't matter a little bit but every day, that's no, no. Yeah.
Because it interferes with the warfarin?
Yeah. Yeah.
Although many found they experienced no side effects of anti-clotting drugs some said that they had noticed that they bruised much more easily. People who took warfarin could sometimes have problems stopping bleeding from cuts.
She is on warfarin and knows she has to limit the amount of alcohol she drinks. She has had some...
She is on warfarin and knows she has to limit the amount of alcohol she drinks. She has had some...
Well, yes. I mean, you know, it's just to stop the blood clots that can form in the heart when you get these irregular heart beats every now and again and it forms clots in your heart that go to your brain and they reckon if I took warfarin, it would virtually prevent that happening so that I wouldn't have another stroke. So I'm on warfarin. It will be forever unless they find something else I suppose. But again, I, people say, 'Well, you mustn't drink too much, you mustn't eat too much' but I don't drink very much anyhow. Very rarely drink in England. If I drink, I drink down in France, then only wine and certainly not to excess but I, I don't find that warfarin affects me in any way at all. I don't find that any of my medication affects me. I never have any side effects or feel peculiar with it or, you know, you read the leaflets sometimes and they say this medicine can do this to you or that to you and you think, 'Oh goodness, what am I taking?' but I've never had any side effects, so.
Do you have any problems with bruising or anything like that?
Yes. If I cut myself it sort of bleeds, I think it was last, last summer we came back from France and someone at the airport ran over my foot with their trolley or their suitcase I forget what it was now and just sliced the end of my toe off there and it was terrible to stop it bleeding. It really was absolutely dreadful mess. And it just came up in the most huge scab and it didn't get any better because it still started oozing very pale pink liquid from underneath the scab. So in the end I had to go down to the doctor they had to take the scab off and wrap it all up and start again but it just makes things longer healing. I can find odd bruises on myself from time to time if I don't know how, I don't remember sort of hitting myself or anything like that and then we were down in France I did some gardening and I scratched all my arms up here, you know, how you do with, you know, cutting back plants and things and, and that looked far worse than it would have normally done without warfarin I think. But that's about all. I don't, I really can't complain because it's doing, doing a good job.
People taking warfarin need regular blood tests to check that the dose is right, but there are newer drugs to reduce blood clots such as dabigatran, apixaban and rivaroxaban which do not need any blood tests and they may be used more often in the future.
See the Stroke Association leaflet ‘Blood thinning medication after stroke’ for more information on blood thinning medication.
Medication to reduce cholesterol
High cholesterol is a risk factor for stroke and many people had been prescribed a statin drug to help reduce their cholesterol following their stroke there are several available such as atorvastatin, simvastatin and rosuvastatin. There is evidence to suggest that statins are beneficial in preventing a further stroke irrespective of the person's cholesterol level. A young woman explained that she had been put on a statin as a precaution even though her cholesterol level was okay.
She was put on a statin as a precaution even though she doesn't have high cholesterol.
She was put on a statin as a precaution even though she doesn't have high cholesterol.
Yeah. I've had to take aspirin daily and that's to thin the blood and simvastatin.
What's the simvastatin for? What's that for?
That's a cholesterol lowering tablet. Just a small dosage of that though.
So was your cholesterol level high when you had it tested?
No. No. Cholesterol was fine. They couldn't find anything wrong' at all' But they put it down to, they put the stroke down to smoking and' being on the pill. But the doctors, well, a couple of doctors told me that they couldn't see anything to suggest that that's what it was because the arteries were clear and they couldn't see any, they would, they would have expected to see evidence but they've got to put it down as something, so they put it down as smoking and being on the pill. The cholesterol tablet, my blood pressure was fine, my cholesterol levels were fine but they put me on that just to be on the safe side, just as a precaution.
And how do you feel about having to take the medication?
It doesn't bother me in the slightest, I just take it and I know it's for my own good, it's no going to do any harm, it's nothing strong, I mean, aspirin's not strong and the simvastatin, so it doesn't bother me.
Several people explained that they needed to take their statin at night as this was when the cholesterol was formed.
His doctor explained that there are two types of statin but the one he was taking needed to be...
His doctor explained that there are two types of statin but the one he was taking needed to be...
Out of the 4, I take 3 in the morning and the simvastatin, I'm told there's two types, two types of statins. The type I've got is simvastatin and that's to be taken at night because that's when it fights the cholesterol. That, again, has been explained to me [laughter], that the cholesterol is formed at night when you're sleeping and I usually take this simvastatin it's called. The reason I take it at night is because the cholesterol is formed at night. So that's why but again, it's no problem. It's just remembering. Remembering that you've still got a pill to take before you go to your bed, you know. But apart from that, it's fine. Aye, it's fine.
Most people said that they did not have any side effects from the statins. One woman had experienced some hair loss and had changed to a different statin. A man had some itchiness which he thought might be due to the statin and a woman felt she had put on weight since being on the statin.
Last reviewed June 2017.
Last updated June 2017.
Copyright © 2024 University of Oxford. All rights reserved.