By Neil A. Willsey, R.Ph.
A stroke is defined as the rapidly developing loss of brain function(s) due to a disturbance in the blood supply to the brain. A stroke is also known as a cerebrovascular accident (CVA) or a “brain attack.” A stroke is always considered a medical emergency, and we are hearing the phrase these days that with strokes, “time saved is brain saved.” This implies that the sooner a stroke can be treated medically, the more the risk of permanent brain damage can be reduced. Strokes begin to cause damage to brain cells within minutes.
There are basically two kinds of strokes. The more common kind is called an ischemic stroke (87%), which is caused by a blood clot that blocks a blood vessel somewhere in the brain or in a vessel supplying the brain. The other kind of stroke is a hemorrhagic stroke (13%), which results from a blood vessel rupturing and thereby causing bleeding into the brain. There is also what is referred to as a mini-stroke, or transient ischemic attack (TIA), where the blood supply to an area of the brain is only briefly interrupted. These so-called mini-strokes can be a warning sign of the potential for an actual stroke to occur.
The Symptoms of a Stroke Include:
- Sudden numbness or weakness of the face, arm or leg (especially on one side of the body)
- Sudden confusion, trouble speaking or understanding speech
- Sudden trouble walking, dizziness, loss of balance or coordination
- Sudden severe headache with no known cause
If you or someone you know has any of these symptoms, you must get him or her to a hospital quickly to begin treatment. The therapies for trying to stop a stroke while it is happening include the use of “clot-busting” drugs (TPA). In the case of a hemorrhagic stroke, the medical team will try to stop the bleeding.
Statistics from the American Heart Association indicate that each year about 795,000 people experience a new or recurrent stroke. About 600,000 of these are first attacks. Strokes accounted for about one of every 17 deaths in 2005, with stroke mortality for that same year of over 143,000.
The cost of caring for a stroke patient is significant. The American Heart Association estimates that the direct and indirect cost of stroke for 2009 is $68.9 billion. Reducing the occurrence of strokes by lowering the risk factors could decrease some of this enormous financial cost, along with alleviating the emotional burden on the families of those afflicted.
Risk Factors for Stroke Include:
- High blood pressure
- Atrial fibrillation
- High blood cholesterol
- Lack of physical activity
- Unhealthy diet
Medications Used in Stroke Prevention
Medications used to prevent stroke include the oral anticoagulant warfarin (Coumadin®) and also aspirin. These work by inhibiting the formation of blood clots, which are the direct cause of thrombotic strokes. These are strokes where a blood clot either partially or completely blocks the flow of blood in the vessel where the clot sits.
Typically, patients who have atrial fibrillation are given warfarin to prevent clots, which may form in the atrial chamber as a result of this condition. If the clots can be prevented, this would then reduce the risk of a stroke occurring in patients with atrial fibrillation. Patients on warfarin need frequent monitoring of their blood to determine that the clotting times are within the desired range.
Aspirin, in combination with dipyridamole (Aggrenox®), is another common treatment aimed at preventing the formation of clots in patients at risk of stroke. Clopidogrel (Plavix®) and Ticlopidine (Ticlid®) are also used for their ability to inhibit the aggregation or “clumping” of platelets, which is a way of inhibiting the formation of blood clots.
Patients who are prescribed any of these medications for the prevention of strokes should be careful about combining these with any other medications, prescription or over-the-counter, as there could be the potential for increased risk of bleeding. Anyone taking these medications who observes heavy or nonstop bleeding should seek immediate medical attention.
This is a quick way to assess whether or not a person may be having a stroke:
- Face – Ask the person to smile. Does one side of the face droop?
- Arms- Ask the person to raise both arms. Does one arm drift downward?
- Speech – Ask the person to repeat a simple sentence. Are the words slurred? Can the person repeat the sentence correctly?
- Time – If the person shows any of these symptoms, time is important. Call 911 or get to the hospital fast. Brain cells are dying.
Neil A. Willsey, R.P., is a registered pharmacist at ValuMarket Pharmacy, located at 7519 Outer Loop.