Thursday, August 11, 2011
TAKING CARE OF A PATIENT AFTER BRAIN STROKE
MAKING LIFE BETTER AFTER BRAIN STROKE (PART 1)
Stroke is one of the four leading causes of death and disability in the world (the other three being heart attack, cancer and road traffic accidents). Stroke is common in all countries and in all races. The prevalence of stroke increases with age; however, the average age of stroke patients is much lesser in India & other Asian countries. This is because of higher incidence of hypertension (high blood pressure), more infections, dietary habits and other lifestyle differences.
The medical treatment of brain stroke has been rapidly advancing with thrombolytic therapies (drugs to dissolve the blood clot) and better intensive/acute care. However, a significant proportion of people are left with disabilities after stroke. The aim of this article is to focus on aspects of stroke care after the discharge from the hospital. Part 1 will focus on the medical (drugs and medications) aspects. Part 2 (next article) would focus on the non-drug aspects.
A stroke survivor is supposed to take a number of medications. In this section, I will discuss the rationale and precautions for them.
1. Antiplatelet drugs: These are drugs which prevent the recurrence of brain stroke. They are also called as "blood thinners". Common medicines in this category include aspirin (ecosprin) and clopidogrel (plavix, clopitab, etc). These medicines are required lifelong. These should be taken after food. The main side effects of these drugs is bleeding. So, if you notice any bleeding such as gum bleeding while brushing, blood in urine, blood vomiting, etc, you should report to your doctor. Sometimes, bleeding may happen in the skin, resulting in reddish or bluish discoloration. Other precaution to be taken is that these drugs should be stopped for 3-5 days prior to any procedure or surgery, including extraction of teeth, etc. If a surgery is done while the patient is taking aspirin, there is a higher chance of bleeding during or after the surgery. One more side effect of aspirin is gastritis or acidity, which should be reported to the doctor.
2. Statins: Statins are universally prescribed to patients with brain stroke. They are cholesterol lowering drugs. These drugs have dual benefit- in addition to lowering the blood cholesterol, they also prevent the recurrence of brain stroke and heart attack (even in patients with normal blood cholesterol). Common drugs in this category are atorvastatin and rosuvastatin. It is commonly taken at bed time after dinner. Statins are generally safe, however, muscle aches and pain (myalgias) may occur and it should be reported to the doctor. Statins are also required for long-term.
3. Medicines for control of risk factors:
a) Diabetes mellitus- Medicines to keep the blood sugar under control (oral tablets or insulin) are required in patients with diabetes; and the dose needs to be adjusted as per sugar levels in the blood. One should watch for signs of hypoglycemia (low sugar) such as weakness,hunger, sweating, palpitations, etc.
b) Hypertension- Patients with high blood pressure need medicines to keep their BP in control. Blood pressure and sugars should be regularly checked and the dose of medications adjusted as per the levels found. These medicines are also required lifelong.
c) Cardiac drugs- Many patients may have co-existing cardiac illness and they should continue their cardiac medications as per the cardiologist advice. It should be noted, however, that there are several common medications (for heart and brain disease); so, do not forget to check with your doctor about any duplication of the drugs (show them the cardiologist prescription).
d) Drugs to lower homocysteine such as folic acid/pyridoxine may be required in some cases, where the serum homocysteine is found to be high.
4. Anticoagulants such as acitrom or warfarin is given to patients with cardio-embolic strokes (clots form in the heart and travel to brain causing brain stroke). Common indications are atrial fibrillation (AF), people with prosthetic heart valves, LV clot, very foor heart function (LV dysfunction, etc). Dose of anticoagulants is adjusted on the basis of a blood test- prothrombin time (PT/INR). So, a patient on warfarin should regularly check PT/INR and report to the doctor, so that the dose can be adjusted.
In summary, patients with stroke are supposed to take a number of medications for different purposes. One should write down all the medications to be taken on a single page with the timings (and before food, after food, etc); and get it verified by your doctor. As the stroke patient may not remember, the caregiver should verify if the medications are taken as per the instructions given by your doctor. Remember to discuss the indication and side effects of each drug which the patient is taking with your doctor. These simple points can make a remarkable difference in the life of a stroke survivor.
DR SUDHIR KUMAR MD (MEDICINE) DM (NEUROLOGY)
SENIOR CONSULTANT NEUROLOGIST
APOLLO HOSPITALS, JUBILEE HILLS, HYDERABAD