The timing matters
Medically reviewed by Huma Sheikh, MD
Stroke treatment is complicated. The timing of different types of stroke treatment is crucial to achieving the best outcome.
Immediate stroke intervention often focuses on medical stabilization. Sometimes blood thinners can dissolve a blood clot. Prompt medical care can reduce the severity of brain damage caused by a stroke.
The next few days after a stroke involve close monitoring, often with careful adjustment of medications to help optimize recovery. When the effects of a stroke have stabilized, management focuses on rehabilitation and stroke prevention.
This article describes the different types of stroke treatment and the sequence and timing of each type.
Types of stroke include:
Ischemic stroke, the most common stroke type, is brain damage caused by ischemia (a lack of blood supply) to a region of the brain.
Hemorrhagic stroke, considered the most dangerous, is caused by bleeding in the brain.
Transient ischemic attack (TIA) is a temporary period of ischemia in the brain that resolves on its own before permanent damage occurs. Stroke risk factors cause a TIA, and it’s a sign that someone is at risk of having a stroke.
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Importance of Timing in Stroke Treatment
Stroke treatment includes many different types of therapies:
Each treatment has a specific time during which it can be beneficial and safe. Some treatments that can be lifesaving during certain stages of a stroke could be useless or dangerous when applied at a different time in stroke care.
Which Stroke Treatment Works Best?
Stroke treatment is individualized based on the type of stroke, how long symptoms have lasted, how soon a person gets to the hospital, and underlying medical conditions. The best treatment for one situation isn’t the best for another situation.
Order of Stroke Treatment and Time Window
A stroke is a medical emergency. Though a stroke often means a person will need long-term care, immediate treatment is crucial. Getting prompt treatment for stroke symptoms can help prevent or reduce permanent brain damage. This can improve your ability to recover.
It’s important to recognize stroke symptoms, which may involve sudden:
If you or anyone experiences stroke symptoms, it is important to call 911 immediately. There is no treatment for a stroke that you can administer at home. Do not delay getting emergency medical treatment. Learn the FAST warning signs of strokes:
Treatment for a stroke follows this sequence:
Prompt transportation to a hospital
Rapid evaluation by emergency healthcare responders
Medical stabilization of heart rate, respiration (breathing), blood pressure, oxygen, and fluid concentration
A rapid brain computerized tomography (CT) scan to identify whether there is a hemorrhage (bleeding in the brain)
At this point, administration of intravenous heparin, tissue plasminogen activator (TPA), or an interventional procedure to remove a blood clot may serve as treatment. These therapies can be valuable in immediate stroke care but also raise the risk of bleeding anywhere in the body, including the brain.
Surgical intervention may be an option when there are:
A large brain hemorrhage: Evacuation of blood can help relieve pressure on the brain, potentially reducing the likelihood of extensive brain damage.
Severe swelling in the brain: Temporary surgical removal of a portion of the skull may help provide space to reduce pressure and brain damage.
The Role of Blood Thinners in Stroke Treatment
Blood thinners are common treatments for acute stroke treatment and stroke prevention.
Sometimes, within a few hours of an ischemic stroke, intravenous heparin or TPA, or intra-arterial thrombolytics are administered to dissolve a blood clot or to prevent a blood clot from enlarging.
Anticoagulants and antiplatelet agents can be used for preventing recurrent stroke in certain situations, such as carotid artery disease or an irregular heart rhythm.
Some of the blood thinners used daily to prevent a stroke may include:
Stroke Treatment in Recovery
The body may begin to recover in the hours and days after a stroke. Still, it can also undergo a stress response that may cause inflammation, swelling, fluctuations in breathing, heart function, glucose levels, and fluid and electrolyte balance.
Medical care can help maximize recovery and reduce the likelihood of lasting damage.
This can include:
Monitoring and managing heart rate irregularities
Control of blood pressure
Oxygen supplementation, if necessary
Fluid, glucose, and electrolyte management
Stroke recovery can be distressing. That’s because one aspect of recovery is improved awareness of the stroke. You might begin to realize that you’ve had a stroke, and the reality of noticing lost abilities can be upsetting.
Long-Term Stroke Treatment and Management
After stroke recovery, coping, treatment, and prevention are likely to remain an ongoing part of your life.
Rehabilitation and Coping
Your life may change significantly after a stroke. The effects of a stroke vary widely. For example, a stroke can cause loss of peripheral vision, weakness on one side of the body, impaired balance, post-stroke headaches, and more.
One of the main components of long-term coping involves identifying the new disabilities that have occurred due to a stroke. When you and your healthcare providers have clearly defined the effects of your stroke, you can work together to create a long-term plan.
This may include physical therapy and rehabilitation, often with some occupational therapy. Speech and swallow therapy can help if you have developed difficulties with communication or impaired control of your chewing and swallowing abilities.
Medication can often help if you have developed post-stroke pain, such as headaches or muscle aches.
Additionally, you may need to make some adjustments to your day-to-day life. These can include using a walker, reassessing whether it’s safe to drive, or cutting back on work or other responsibilities.
Over time, many people continue to experience improvement after a stroke, so it’s important that you remain optimistic even after your initial recovery stage.
Many people feel depressed, anxious, or both after a stroke. If you have these feelings, having a diagnostic assessment and initiating appropriate treatment can help. Getting a mental health evaluation after a stroke and starting treatment early can prevent your mental health from worsening.
Treatment may include counseling and medication. Some people benefit more from counseling, some from medication, and some from a combination. You and your healthcare providers can determine the most effective approach.
Many people who have had a stroke remain at risk of another stroke. Consideration of risk factors is an important aspect of stroke care. Prevention involves a combination of medication, procedures, or lifestyle adjustments.
Medical tests can help identify your stroke risk factors, and you can treat many of the risk factors can to reduce your risk of another stroke substantially.
Tests and treatments for stroke risk factors include:
Electrocardiogram (EKG/ECG): This fast, noninvasive test can detect heart rhythm abnormalities. Irregularities like atrial fibrillation can increase the risk of stroke and be treated with medication or surgery. A wearable portable ECG recorder (Holter monitor) may detect an arrhythmia over the course of 24 or 48 hours.
Carotid ultrasound: The carotid arteries, which run in the neck, can become narrow or filled with atherosclerotic plaque. This can increase the risk of stroke. There are guidelines to direct treatment for carotid disease, which may include medication or surgery to reduce the risk of a first or recurrent stroke.
Blood tests: Many health problems that can be reflected in blood tests are known to increase the risk of stroke. These problems include diabetes, high cholesterol, and inflammatory diseases. Medication can treat these conditions, lowering your risk of stroke.
Managing blood pressure: You can use a home blood pressure monitor or periodically check your blood pressure to determine how well you're controlling your blood pressure. Medication can often treat high blood pressure, substantially reducing the risk of vascular disease and stroke.
Blood thinners: These medications can often help reduce the risk of a stroke. Your diagnostic testing will help your healthcare providers determine whether you need to take blood thinners.
Stroke treatment that’s initiated within a few hours of the first stroke symptoms can help prevent stroke damage and may also minimize the severity of the damage. Early stroke treatments can include blood thinners, intra-arterial blood clot treatment, and management of blood pressure, heart function, fluid levels, electrolytes, and oxygen.
Sometimes surgical treatment is necessary if a stroke results from bleeding or if swelling in the brain is severe and treatable. Within the first few days after a stroke, medical management can help augment recovery. Intravenous blood thinners may prove necessary during this time as well.
After you or your loved one has stabilized, rehabilitation is key to regaining the best quality of life possible. Preventing another stroke is also important and may require taking oral blood thinners and managing medical stroke risk factors.
Read Next: The 7 Stages of Stroke Recovery