Ask The Expert – Preventing a Blood Clot After Stroke

“I recently suffered from a stroke. Going forward, what can I do to reduce my risk of another thrombotic event?”

The risk of another thrombotic event is increased after an initial stroke. These post-stroke complications include recurrent cerebrovascular events such as another stroke, cardiovascular events such as myocardial infarction (MI, or heart attack), and venous thromboembolic (VTE) disease such as deep vein thrombosis (DVT, or blood clots in the legs) or pulmonary embolus (PE, or blood clot in the lungs). It is important to talk with your physician after a stroke to discuss the cause of your stroke and to follow his or her recommendations for ways to prevent another thrombotic event.

Certain medications are essential in reducing the risk of a recurrent thrombotic event. The type of medications used in preventing recurrent stroke depends on the etiology or cause of the initial thrombosis. Anticoagulants, antiplatelet agents, blood pressure medications, statins, and medications for diabetes may be a part of this medical regimen.

Anticoagulants are a class of potent blood thinning medications, which include warfarin, dabigatran, rivaroxaban, apixaban, and edoxaban. Anticoagulants are used to treat and prevent blood clots that can form inside the heart or blood vessels. They are particularly useful in preventing recurrent ischemic strokes in people with atrial fibrillation, in which there is a high tendency to form clots in the heart. Anticoagulants are also used to treat DVT and PE.

Antiplatelet agents are group of medications that includes aspirin, clopidogrel (Plavix), and aspirin-dipyridamole (Aggrenox). These medications are used to prevent blood clots from forming within an artery such as the carotids in the neck or coronaries in the heart.

Atherosclerotic or plaque disease is a risk factor for recurrent thrombotic events. Atherosclerosis and associated clot formation may lead to MI if the coronary arteries are involved and cause stroke if in the head and neck arteries. Hypertension (high blood pressure), hyperlipidemia (high cholesterol), and diabetes can contribute to atherosclerosis. Medications and other ways to treat these processes are crucial to reducing recurrent thrombotic events.

Smoking cessation and abstinence is an important lifestyle modification recommended for reducing risk of thrombotic events. Tobacco causes damage to the lining of arteries and is a major risk factor for atherosclerotic disease. Smoking also affects blood-clotting factors and increases risk of VTE. A variety of cessation strategies are available, ranging from medications to nicotine replacement to non-pharmacologic aids, such as counseling and support.

Making changes for a healthy diet also plays a role in reducing risk of another thrombotic event after stroke. Consuming less sodium or salt can help to lower blood pressures. A diet rich with fruits, vegetables, low-fat dairy and proteins, and low in red meats, sweets, and refined carbohydrates (white bread, rice, and pastas) is recommended. No more than one daily serving of alcohol for women and two for men is recommended for maintaining cardiovascular and cerebrovascular health.

A sedentary lifestyle and obesity are risk factors for vascular disease in the heart, brain, and venous systems. Thus physical activity and weight loss may be pursued to reduce the risk of recurrent thrombotic events after stroke. Between 30-35 minutes of moderate aerobic exercise (such as brisk walking or jogging) for 5 days weekly is recommended. There is a wide range of exercises that can be done – the key is to get the heart rate up during the physical activity. Exercise is also beneficial for long-term brain health after stroke. Make sure to get ample water to prevent dehydration during physical activities!

Fan Caprio, MD
Assistant Professor of Neurology
Division of Stroke and Neurocritical Care
Ken and Ruth Davee Department of Neurology
Northwestern University Feinberg School of Medicine

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