Posterior Cerebral Artery Stroke Medication

  • Author: Erek K Helseth, MD; Chief Editor: Helmi L Lutsep, MD  more...
Updated: Sep 15, 2016

Medication Summary

As previously mentioned, long-term anticoagulation to prevent recurrent strokes is indicated in several settings, including the following:

  • Atrial fibrillation
  • Selected cases with significant global or regional cardiac hypokinesis (ejection fraction < 35%)
  • Patent foramen ovale with documented hypercoagulable condition
  • Arterial hypercoagulable state

When no cause for recurrent strokes can be found, antiplatelet therapy—eg, with aspirin, ticlopidine, clopidogrel, or aspirin plus extended-release dipyridamole (Aggrenox)—is generally recommended instead of anticoagulation therapy.


Hematologic Agents

Class Summary

Patients entering the rehabilitation phase of their hospital course may be prescribed warfarin, clopidogrel, or aspirin. The selection of these agents is dependent on the etiology of the posterior cerebral artery (PCA) stroke, associated complications, comorbidities, and prior medical history. These medications are used to prevent further cerebral vascular ischemic events.

Warfarin (Coumadin, Jantoven)


Warfarin interferes with the hepatic synthesis of vitamin K-dependent coagulation factors. It is used for the prophylaxis and treatment of venous thrombosis, pulmonary embolism, and thromboembolic disorders. Tailor the dose to maintain an INR in the range of 2-3. Patients with prosthetic cardiac valves may require higher INR levels.

Clopidogrel (Plavix)


Clopidogrel selectively inhibits adenosine diphosphate (ADP) from binding to the platelet receptor and the subsequent ADP-mediated activation of glycoprotein GPIIb/IIIa complex, thereby inhibiting platelet aggregation.

Aspirin (Bayer Aspirin, Ascriptin Maximum Strength, Ecotrin, Bufferin)


Aspirin treats mild to moderate pain and headache. It inhibits prostaglandin synthesis, which prevents the formation of platelet-aggregating thromboxane A2.



Ticlopidine is second-line antiplatelet therapy for patients in whom aspirin is not tolerated or is ineffective.

Dipyridamole 200 mg/aspirin 25 mg (Aggrenox)


Dipyridamole-aspirin is a combination antiplatelet agent that takes advantage of the additive antiplatelet effects of the 2 drugs. Dipyridamole acts via the adenosine-platelet A2-receptor system, whereas aspirin inhibits platelet aggregation by causing irreversible inhibition of cyclooxygenase system, thereby reducing generation of thromboxane A2, a powerful enhancer of platelet aggregation and vasoconstriction.

Contributor Information and Disclosures

Erek K Helseth, MD Fellow, Vascular and Interventional Neurology, Oregon Health and Science University School of Medicine

Erek K Helseth, MD is a member of the following medical societies: American Academy of Neurology

Disclosure: Nothing to disclose.

Chief Editor

Helmi L Lutsep, MD Professor and Vice Chair, Department of Neurology, Oregon Health and Science University School of Medicine; Associate Director, OHSU Stroke Center

Helmi L Lutsep, MD is a member of the following medical societies: American Academy of Neurology, American Stroke Association

Disclosure: Medscape Neurology Editorial Advisory Board for: Stroke Adjudication Committee, CREST2.


Alastair M Buchan, DSc, MBBCh Professor, Head of Medical Sciences Division, University of Oxford, UK

Disclosure: Nothing to disclose.

Michael D Hill, MD Medical Director, Stroke Unit, Associate Professor of Neurology, Department of Clinical Neurosciences, Foothills Hospital, University of Calgary, Canada

Michael D Hill, MD is a member of the following medical societies: Alberta Medical Association ; American Academy of Neurology; American College of Physicians; American Stroke Association; Canadian Medical Association; and Royal College of Physicians and Surgeons of Canada

Disclosure: Nothing to disclose.

Thomas A Kent, MD Professor and Director of Stroke Research and Education, Department of Neurology, Baylor College of Medicine; Chief of Neurology, Michael E DeBakey Veterans Affairs Medical Center

Thomas A Kent, MD is a member of the following medical societies: American Academy of Neurology, American Neurological Association, New York Academy of Sciences, Royal Society of Medicine, Sigma Xi, and Stroke Council of the American Heart Association

Disclosure: Nothing to disclose.

Howard S Kirshner, MD Professor of Neurology, Psychiatry and Hearing and Speech Sciences, Vice Chairman, Department of Neurology, Vanderbilt University School of Medicine; Director, Vanderbilt Stroke Center; Program Director, Stroke Service, Vanderbilt Stallworth Rehabilitation Hospital; Consulting Staff, Department of Neurology, Nashville Veterans Affairs Medical Center

Howard S Kirshner, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Neurology, American Heart Association, American Medical Association, American Neurological Association, American Society of Neurorehabilitation, National Stroke Association, Phi Beta Kappa, and Tennessee Medical Association

Disclosure: Nothing to disclose.

Consuelo T Lorenzo, MD Physiatrist, Department of Physical Medicine and Rehabilitation, Alegent Health Immanuel Rehabilitation Center

Consuelo T Lorenzo, MD is a member of the following medical societies: American Academy of Physical Medicine and Rehabilitation

Disclosure: Nothing to disclose.

Christopher Luzzio, MD Clinical Assistant Professor, Department of Neurology, University of Wisconsin at Madison School of Medicine and Public Health

Christopher Luzzio, MD is a member of the following medical societies: American Academy of Neurology

Disclosure: Nothing to disclose.

Elizabeth A Moberg-Wolff, MD Medical Director, Pediatric Rehabilitation Medicine Associates

Elizabeth A Moberg-Wolff, MD is a member of the following medical societies: American Academy for Cerebral Palsy and Developmental Medicine and American Academy of Physical Medicine and Rehabilitation

Disclosure: Medtronic Neurological None Speaking and teaching

Richard Salcido, MD Chairman, Erdman Professor of Rehabilitation, Department of Physical Medicine and Rehabilitation, University of Pennsylvania School of Medicine

Richard Salcido, MD is a member of the following medical societies: American Academy of Pain Medicine, American Academy of Physical Medicine and Rehabilitation, American College of Physician Executives, American Medical Association, and American Paraplegia Society

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Medscape Salary Employment

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Unenhanced head computed tomography (CT) scan demonstrating a subacute L posterior cerebral artery (PCA) infarct.
Unenhanced head computed tomography (CT) scan demonstrating hemorrhagic conversion of an ischemic stroke, approximately 72 hours after symptom onset.
Brain magnetic resonance imaging (MRI) scan demonstrating acute stroke. Diffusion restriction is seen on diffusion-weighted imaging.
Magnetic resonance (MR) angiogram demonstrating bilateral fetal posterior cerebral artery (PCA) variants (black arrows) with the basilar artery terminating in bilateral superior cerebellar arteries (blue arrows).
Digital subtraction angiogram demonstrating an acute L posterior cerebral artery (PCA) occlusion (red arrow) following balloon-assisted coiling of a basilar tip aneurysm.
Digital subtraction angiogram demonstrating revascularization of acute L posterior cerebral artery (PCA) occlusion (red arrow) during a balloon-assisted basilar tip aneurysm revascularization with use of balloon angioplasty.
Computed tomography (CT) scan of the brain showing hypodense areas in the right occipital lobe consistent with a recent posterior cerebral artery (PCA) ischemic infarct.
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