Medicines for preventing stroke
If you have had a stroke, TIA or heart attack in the past, you are at high risk of experiencing another stroke or heart attack.
An anticoagulant (e.g. warfarin) or antiplatelet medicine (e.g. low-dose aspirin) is usually prescribed if you’ve already had an ischaemic stroke or TIA — to prevent one from happening again. This is called ‘secondary prevention’.
These anti-clotting medicines are not routinely prescribed for people who have never had a stroke or who are not at risk of having a stroke (‘primary prevention’).
However, if you are at greater risk of having a stroke because you have a medical condition (e.g. atrial fibrillation) or risk factors for coronary heart disease or stroke, your doctor may prescribe an anti-clotting medicine. Your doctor will take your overall cardiovascular risk into account when deciding whether you need an antiplatelet or an anticoagulant medicine (or both).
Note about medicine names
Most medicines have two names: the active ingredient and the brand name. The active ingredient is the chemical in the medicine that makes it work. The brand name is the name given to the medicine by its manufacturer. There may be several brands that contain the same active ingredient. This website uses active ingredient names, with brand names in brackets. We also discuss medicines in groups or ‘classes’, when their effects or actions are very similar.
Because you may be offered different brands at the pharmacist, knowing your active ingredient (or where to find it) can avoid mix-ups. To find out more, read our information about active ingredients and brand names.
Other anticoagulants that can be used to prevent stroke are:
Note: From 1 August 2013, rivaroxaban will be subsidised by the PBS for preventing stroke in people with atrial fibrillation. Dabigatran and apixaban are currently not subsidised by the Pharmaceutical Benefits Scheme (PBS) for preventing stroke in people with atrial fibrillation.
If you have atrial fibrillation and have previously experienced a stroke, mini-stroke or transient ischaemic attack (TIA) or another blood-clot related complication, warfarin will usually be recommended because of its known benefits in preventing stroke.
People aged over 75 years with atrial fibrillation have a high risk of stroke may be prescribed warfarin even if they don’t have any other risk factors.
Your doctor will consider if there are any reasons why warfarin is not suitable for you.
Find out more about warfarin.
Apixaban, dabigatran, and rivaroxiban
Because apixaban, dabigatran and rivaroxiban are new medicines, their full range of side effects and interactions are not known.
Unlike warfarin, there is no equivalent of the INR blood test to check your blood clotting if you are taking apixaban, dabigatran and rivaroxiban. However, apixaban, dabigatran and rivaroxiban can still cause bleeding side effects, so you will still need to have regular health checks and other tests (e.g. to check your kidney function).
Note: From 1 August 2013, rivaroxaban will be subsidised by the PBS for preventing stroke in people with AF. Dabigatran and apixaban are currently not subsidised by the Pharmaceutical Benefits Scheme (PBS) for preventing stroke in people with atrial fibrillation.
Antiplatelet medicines used to prevent stroke include:
- aspirin (brand names e.g. Cartia and Astrix)
- clopidogrel (e.g. Plavix)
- dipyridamole (e.g. Persantin SR)
- prasugrel (Effient)
- ticagrelor (Brilinta)
Aspirin (e.g. Astrix and Cartia) is commonly used to prevent stroke, particularly in people who’ve already had a stroke or a mini-stroke (transient ischaemic attack or TIA).
Aspirin can be combined with dipyridamole to prevent a second stroke, and with warfarin in people who have an artificial heart valve.
Find out more about aspirin.
Clopidogrel (e.g. Plavix, Iscover) is only used for people who can’t take aspirin, for example due to allergy, who can’t tolerate aspirin’s side effects, or for those who have a heart attack or stroke despite taking aspirin.
Clopidogrel can be combined with aspirin. However, don’t take aspirin and clopidogrel together unless specifically advised by your doctor. If you’ve already had a stroke, taking aspirin with clopidogrel might cause you a bleed rather than prevent more strokes.
Dipyridamole is usually combined with aspirin to prevent stroke in people who have already had a stroke or transient ischaemic attack (mini-stroke). It can also be used on its own, especially if you can’t take aspirin or clopidogrel because of side effects.
Phone for medicines information
Call NPS Medicines Line on 1300 MEDICINE (1300 633 424) to get information about your prescription, over-the-counter and complementary medicines (herbal, ‘natural’, vitamins and mineral supplements) from a pharmacist. Your call will be answered by healthdirect Australia (except Queensland and Victoria).
Who can I ask about side effects?
If you’re concerned that you or someone in your care is having side effects related to a medicine, seek medical advice.
To report and discuss possible side effects, call the Adverse Medicines Events (AME) line on 1300 134 237 from anywhere in Australia (Monday–Friday, 9am–5pm AEST).
- Rossi S, (ed). Australian Medicines Handbook. Australian Medicines Handbook Pty Ltd, 2013.
- Gallus AS, Baker RI, Chong BH et al. Consensus guidelines for warfarin therapy. Med J Aust 2000;172(12):600–5. www.mja.com.au/public/issues/172_12_190600/gallus/gallus.html (accessed 14 June 2013).
- Borosak M, Choo S, Street A. Warfarin: balancing the benefits and harms. Australian Prescriber 2004;27:88–92. www.australianprescriber.com/magazine/27/4/88/92 (accessed 14 June 2013).
- NPS Medicine Update. Dabigatran (Pradaxa) for preventing stroke in people with atrial fibrillation. 2011. www.nps.org.au/__data/assets/pdf_file/0009/129672/110805_08_Medicine_Update_Dabigatran_AF.pdf (accessed 14 June 2013).