Variable platelet response to aspirin and clopidogrel is a well-known phenomenon in patients with coronary artery disease and ischemic cerebral stroke. The objective of the present study was to evaluate the frequency and possible risk factors of antiplatelet resistance in patients with cerebrovascular and cardiovascular diseases. The VerifyNow system was used to evaluate adenosine-5-diphosphate and platelet P2YI2 receptor function in patients with cerebrovascular and cardiovascular disease, who received dual antiplatelet therapy. Aspirin resistance was defined as aspirin reaction units (ARU) ≥ 550. Clopidogrel resistance was defined as Platelet Reaction Units (PRU) > 230. In the group of cerebrovascular diseases there were 13.2% (n = 27) patients with aspirin and 24.5% (n = 50) with clopidogrel resistance. However, in the cardiovascular group there were 20% (n = 9) aspirin and 11.1% (n = 5) clopidogrel resistant patients. In the cerebrovascular group, aspirin resistant patients had a lower triglyceride level (p = 0.001, r = 0.26) than aspirin sensitive patients. Clopidogrel resistant patients had a significantly higher level of glycated haemoglobin (HbA1C) (p = 0.016, r = 023), triglycerides (p = 0.033, r = 0.16) and lower level of high-density lipoproteins (p = 0.027, r = 0.16) than clopidogrel sensitive patients. In the cardiovascular group, patients who were resistant to aspirin had a significantly higher high-density lipoprotein level (p = 0.038, r = 0.31). No other factors differed significantly between the aspirin or clopidogrel resistant and sensitive patients in the cardiovascular group. Aspirin resistance was more common in patients with cardiovascular disease, and clopidogrel resistance in patients with cerebrovascular disease, although the difference was not significant. Our findings indicate that diabetes mellitus and an elevated level of lipoproteins could be risk factors for aspirin or clopidogrel resistance in patients with cerebrovascular diseases. Further studies should be conducted using larger patient cohorts with balanced groups of patients to investigate clinical aspects of antiplatelet resistance.

The aim of this study was to explore clinical-epidemiological characteristics of migraine in Latvia and the disability of migraine patients, to determine the optimal options for care of these patients. Patients selected from three headache centres were asked 40 questions by phone. Among 116 patients, the dominant age group was 25-34 (41.4%) and most patients were women (87.9%). 52.6% of patients were highly educated, and 53.4% had a job involving communication with people. In 56.9% of cases headaches started at the age of 15-24. About 25% migraine attacks lasted for 25-48 hours. The diagnosis “Migraine with aura” was confirmed in 50% of the patients. Headaches were quite frequent: 4-8 times a month or more in 22.4% of patients and 2-4 times a month in 29.3%. As medication, 50.9% used selective serotonin 5-HT (5- hydroxytryptamine) receptor agonists for migraine attacks treatment, 35.3% - nonsteroidal anti-inflammatory drugs (NSAIDs) and 30.2% - acetaminophen-containing medicines. The average quality of life estimated by migraine disability assessment questionnaire (MIDAS) was 13.0, which equates to moderate disability. According to our study clinical characteristics of migraine in Latvia do not differ significantly from that of other European countries. Most of the patients are educated, working women of childbearing age. Migraine diagnosis and treatment seems to be appropriate, but nevertheless, too many sufferers have frequent and persistent headache attacks that require further investigation.