Prevalence of Aspirin and Clopidogrel Resistance Among Patients With and Without Drug-Eluting Stent Thrombosis

Clopidogrel Resistance Is Associated with Thromboembolic Complications in Patients Undergoing Neurovascular Stenting

“…6,20 There is growing literature from cardiology intervention patients that shows an association between clopidogrel resistance and clinical events. 8,9,21,22 While antiplatelet drug resistance has been described in neurovascular patients, an effect on clinical events has not been previously reported. [10][11][12][13] Our study demonstrates that clopidogrel resistance is clinically relevant and can lead to complications during neurovascular stent-placement procedures.…”

“…Observational studies from the cardiovascular literature have demonstrated a relationship between clopidogrel resistance and the development of cardiovascular events after PCI. 8,9 Antiplatelet drug resistance has not been well-characterized in patients undergoing neurovascular stent placement. In recent years, a few studies in patients after neurovascular stent placement revealed similar rates of resistance for aspirin and clopidogrel compared with the rates in the cardiovascular literature.…”

Aspirin Resistance: Current Status and Role of Tailored Therapy

“…36 Similarly, among patients who have developed stent thrombosis, 43% of patients were resistant to both aspirin and clopidogrel compared to 14% of controls. 38 Aspirin-resistant patients appear to have platelets that are more sensitive to ADP, which may partially explain the high prevalence of dualantiplatelet resistance in this population. 39 Furthermore, arachidonic acid appears to be able to incompletely activate platelets through an ADP-dependent and COX-independent pathway in COX-inhibited cells, suggesting some overlap in these pathways.…”

“…Those with a history of stent thrombosis had a higher but nonsignificant fraction of immature platelet cells, suggesting that rapid platelet turnover may, in part, contribute to the heightened aspirin resistance in this population. Pinto Slottow et al 38 found that, among patients with a history of stent thrombosis, 23% were aspirin resistant compared to 5% of controls and 43% of patients were resistant to both aspirin and clopidogrel compared to 14% of controls. Interestingly, aspirin resistance in patients with a history of stent thrombosis appears to be more prevalent in early stent thrombosis (<30 days) than late stent thrombosis (>30 days).…”

“…Interestingly, aspirin resistance in patients with a history of stent thrombosis appears to be more prevalent in early stent thrombosis (<30 days) than late stent thrombosis (>30 days). 38 This may be related to heightened inflammation and periprocedural changes to the coronary anatomy after stent implantation, which increases the prothrombotic risk.…”