Keywords
recurrent stroke
aspirin resistance
aspirin
clopidogrel
How to Cite
Abstract
Introduction. Despite the status of acetylsalicylic acid (ASA) as the “gold standard” for secondary stroke prevention, the prevalence of resistance to it varies from 5% to 65%.
Aim. To identify the leading pathogenetic factors for the occurrence of recurrent ischemic events in patients with atherothrombotic stroke (ATS) against the background of standard secondary prevention and to scientifically substantiate the algorithm for choosing personalized antiplatelet therapy depending on individual sensitivity to antiplatelet agents.
Materials and methods. A clinical and neurological examination of 200 patients (116 men, 84 women; mean age 60.4 ± 7.4 years) in the recovery period of ATS was performed. CT/MRI of the brain, ultrasound of extracranial vessels, EchoCG and 72-hour Holter ECG monitoring were performed. The functional activity of platelets was studied by optical aggregometry with the inducer adrenaline. Aspirin resistance (AR) was verified if the degree of aggregation exceeded 60%. Control group – 50 practically healthy individuals. Statistical analysis was performed in STATISTICA 8.0.
Results. During the year of observation against the background of standard therapy (ASA, statins, antihypertensive, hypoglycemic agents) recurrence of ischemic stroke was recorded in 52 patients (26.0%). In 7.69% of cases (n = 4) the cause of the recurrent stroke was the transformation of the pathogenetic subtype of stroke from atherothrombotic to cardioembolic due to the detected paroxysmal atrial fibrillation. Among the remaining 48 individuals with confirmed atherothrombotic genesis of recurrence, AR was confirmed in 47.9% of cases (n = 23), while the degree of platelet aggregation was 85.4 [75.1; 97.2] %, which was 2.01 times higher than the control values (p < 0.01). The detected AR caused a revision of the antithrombotic strategy and the transition from ASA to clopidogrel (75 mg/day).
Conclusions. The main factor in the ineffectiveness of standard secondary prevention in 47.9% of patients with recurrent ATS is laboratory resistance to ASA, which dictates the need for routine aggregometry. Verification of AR is the basis for correction of therapy by replacing ASA with clopidogrel, which provides stabilization of platelet hemostasis through an alternative biochemical mechanism.
References
Shah, J., Liu, S., & Yu, W. (2022). Contemporary antiplatelet therapy for secondary stroke prevention: a narrative review of current literature and guidelines. Stroke and vascular neurology, 7(5), 406–414. https://doi.org/10.1136/svn-2021-001166.
Feske S. K. (2021). Ischemic Stroke. The American journal of medicine, 134(12), 1457–1464. https://doi.org/10.1016/j.amjmed.2021.07.027.
Parsa-Kondelaji, M., & Mansouritorghabeh, H. (2023). Aspirin and clopidogrel resistance; a neglected gap in stroke and cardiovascular practice in Iran: a systematic review and meta-analysis. Thrombosis journal, 21(1), 79. https://doi.org/10.1186/s12959-023-00522-2.
Del Giovane, C., Boncoraglio, G. B., Bertù, L., Banzi, R., & Tramacere, I. (2021). Antiplatelet drugs for secondary prevention in patients with ischemic stroke or transient ischemic attack: a systematic review and network meta-analysis. BMC neurology, 21(1), 319. https://doi.org/10.1186/s12883-021-02341-2.
Yang, Y., Huang, Z., & Zhang, X. (2021). Efficacy and safety of clopidogrel and/or aspirin for ischemic stroke/transient ischemic attack: An overview of systematic reviews and meta-analysis. Medicine, 100(50), e27804. https://doi.org/10.1097/MD.0000000000027804.
Mykhaloiko, O.Ya., Hryb, V.A., Kupnovytska-Sabadosh, M.Yu., Mykhaloiko, I.Ya., & Mykhaloiko, I.S. (2020). Rezystentnist do atsetylsalitsylovoi kysloty u patsiientiv iz perenesenym hostrym ishemichnym insultom. [Resistance to acetylsalicylic acid in patients with acute ischemic stroke]. Bukovynskyi medychnyi visnyk - Bukovina Medical Bulletin, 24(1), 74-78.
Mykhaloiko, O. J., Gryb, V. A., Fabryka, I. M., Hotsaniuk, O. I., Shalamai, U. P., Salyzhyn, T. I., & Mykhaloiko, I. J. (2025). Diagnostic value of lipoprotein-associated phospholipase A2 in patients in the early recovery period of atherothrombotic stroke. Wiadomosci lekarskie (Warsaw, Poland: 1960), 78(6), 1119–1124. https://doi.org/10.36740/WLek/204797.
Khan, H., Kanny, O., Syed, M. H., & Qadura, M. (2022). Aspirin Resistance in Vascular Disease: A Review Highlighting the Critical Need for Improved Point-of-Care Testing and Personalized Therapy. International journal of molecular sciences, 23(19), 11317. https://doi.org/10.3390/ijms231911317
Mykhalojko, O.Ya., Mykhalojko І.Ya. (2023). Potential circulating biomarkers of atherosclerotic plaque vulnerability in patients in the early recovery period of atherothrombotic stroke. Ukrainian Biochemical Journal. (95)1, 58-63. doi: https://doi.org/10.15407/ubj95.01.058.
Lichkova, E., Nakova, V. V., Arsovska, A., Shorova, M., & Stomnaroska, D. R. (2024). Aspirin Resistance and Ischemic Stroke. Prilozi (Makedonska akademija na naukite i umetnostite. Oddelenie za medicinski nauki), 45(2), 37–46. https://doi.org/10.2478/prilozi-2024-0014.
Topçuoglu, M. A., Arsava, E. M., & Ay, H. (2011). Antiplatelet resistance in stroke. Expert review of neurotherapeutics, 11(2), 251–263. https://doi.org/10.1586/ern.10.203
Hvas, A. M., & Favaloro, E. J. (2017). Platelet Function Analyzed by Light Transmission Aggregometry. Methods in molecular biology (Clifton, N.J.), 1646, 321–331. https://doi.org/10.1007/978-1-4939-7196-1_2
Alvitigala, B. Y., Gooneratne, L. V., Constantine, G. R., Wijesinghe, R. A. N. K., & Arawwawala, L. D. A. M. (2020). Pharmacokinetic, pharmacodynamic, and pharmacogenetic assays to monitor clopidogrel therapy. Pharmacology research & perspectives, 8(6), e00686. https://doi.org/10.1002/prp2.686
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