Clinical consequences of aspirin and clopidogrel resistance: An overview

M. D. Mijajlovic, O. Shulga, S. Bloch, N. Covickovic-Sternic, V. Aleksic, N. M. Bornstein

Research output: Contribution to journalReview articlepeer-review

Abstract

The aim of this review is to introduce the concept of personalized medicine in secondary stroke prevention with antiplatelet medication. In the last years, many studies have been conducted regarding aspirin resistance and genotyping of clopidogrel metabolism. A review of the currently published data on this issue emphasizes the importance of focusing on the individualizing approach in antiplatelet therapy to achieve maximal therapeutic beneficial effect. However, many authors suggest that, before new information from ongoing trials become available, good clinical practice should dictate the use of low dose of aspirin that was shown to be effective in the prevention of stroke and death in patients with ischemic cerebrovascular disease, because higher doses do not have significantly better efficacy than lower doses in secondary stroke prevention, but lower-dose aspirin is associated with less side effects. On the other hand, many factors are associated with clopidogrel resistance, and recent genetic studies showed that the CYP2C19*2 genotype (loss-of-function allele) is related to poor metabolism of clopidogrel, but larger studies are needed to definitively confirm or rule out the clinical significance of this genetic effect. The aim of personalized approach in secondary stroke prevention is to take the most appropriate medicine in the right dose in accordance with the clinical condition of the patient and associated risk factors.

Original languageEnglish
Pages (from-to)213-219
Number of pages7
JournalActa Neurologica Scandinavica
Volume128
Issue number4
DOIs
StatePublished - Oct 2013
Externally publishedYes

Keywords

  • Aspirin
  • Clopidogrel
  • Personalized medicine
  • Resistance
  • Secondary stroke prevention

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