Which medication is used to dissolve a clot in ischemic stroke?

• A. Aspirin
• B. Heparin
• C. Tissue plasminogen activator (tPA)
• D. Vitamin K

Answer: (C)

The key idea is dissolving the clot to restore blood flow in an ischemic stroke. The medication used for this purpose is a tissue plasminogen activator, which activates plasminogen to form plasmin, an enzyme that breaks down fibrin in the clot. When given promptly, typically within a narrow time window after symptom onset, tPA can significantly improve outcomes by reestablishing perfusion to endangered brain tissue. Before administration, the patient must have imaging that rules out bleeding (no hemorrhage), and there must be careful assessment of bleeding risk and blood pressure because tPA can cause serious hemorrhage. After administration, vigilant monitoring for signs of bleeding and neurologic changes is essential.

Aspirin is an antiplatelet used to help prevent future clots and may be started after the acute phase if tPA isn’t given or as part of secondary prevention, but it does not dissolve an existing clot. Heparin is an anticoagulant that can hinder clot propagation in some conditions but is not used to dissolve an acute clot in ischemic stroke due to bleeding risk and limited benefit in this setting. Vitamin K is used to reverse warfarin or treat certain coagulation issues, not to dissolve an acute stroke clot.