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Stroke Research and Treatment
Volume 2013 (2013), Article ID 727842, 7 pages
http://dx.doi.org/10.1155/2013/727842
Review Article

Advances in Our Understanding of “Resistance” to Antiplatelet Agents for Prevention of Ischemic Stroke

1Hauenstein Neuroscience Center, 220 Cherry Street SE, Grand Rapids, MI 49503, USA
2Department of Translational Science and Molecular Medicine, Michigan State University College of Human Medicine, 333 Bostwick Avenue NE, Grand Rapids, MI 49503, USA

Received 19 March 2013; Accepted 27 May 2013

Academic Editor: Majaz Moonis

Copyright © 2013 Philip B. Gorelick and Muhammad U. Farooq. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

We review the role of aspirin and clopidogrel for prevention of ischemic stroke and explore the concept of antiplatelet therapy resistance both from a laboratory and clinical perspective and genetic polymorphisms that might influence platelet reactivity with clopidogrel administration. Debates have raged over the years about the application of platelet function tests in clinical practice. We conclude that platelet function testing is not indicated in routine clinical practice. This recommendation is supported by clinical guideline statements, a lack of a global platelet function measure, and limitations of current platelet function test methods as applied in practice. We discuss a recently hypothesized hierarchy of patient characteristics in relation to which patients are most likely to benefit from platelet function studies based on acuity (i.e., risk) of cardiovascular disease. A focus of antiplatelet therapy administration should include emphasis on compliance/adherence and in the example of aspirin, use of well-absorbed forms of aspirin and avoidance of drugs that may interact with aspirin to inhibit its mechanism of action (e.g., certain nonsteroidal anti-inflammatory drugs).