Drug resistance and secondary treatment of ischaemic stroke: The genetic component of the response to acetylsalicylic acid and clopidogrel

Neurologia. Nov-Dec 2015;30(9):566-73. doi: 10.1016/j.nrl.2013.11.003. Epub 2014 Mar 21.
[Article in En, Spanish]


Introduction: Cerebrovascular diseases are among the leading causes of death and disability in developed countries. Acetylsalicylic acid (ASA) and clopidogrel are the most widely-used antiplatelet drugs for secondary prevention of recurrent thromboembolic events. However, there have been cases in which antiplatelet drugs did not inhibit platelet activity; this phenomenon is called resistance, and it may be modulated at the genetic level.

Development: Following a literature search, we reviewed the current state of antiplatelet therapy and covered the different types of resistance to antiplatelet therapy, how it is measured, current problems and limitations, and any genetic factors that have been associated with resistance. We mainly used the Genome Wide Association Studies in the field of ASA and clopidogrel resistance.

Conclusions: We observed an association between different genetic factors and antiplatelet drug resistance as measured by platelet activity. However, there is no evident association between these genetic factors and risk of new thromboembolic events.

Keywords: Acetylsalicylic acid; Antiagregantes; Antiplatelet drugs; Clopidogrel; Farmacogenética; Ictus; Pharmacogenetics; Resistance; Resistencia; Stroke; Ácido acetilsalicílico.

Publication types

  • Research Support, Non-U.S. Gov't
  • Review

MeSH terms

  • Aspirin / therapeutic use*
  • Brain Ischemia / drug therapy*
  • Brain Ischemia / genetics*
  • Clopidogrel
  • Drug Resistance / genetics
  • Platelet Aggregation Inhibitors / therapeutic use*
  • Stroke / drug therapy*
  • Stroke / genetics*
  • Ticlopidine / analogs & derivatives*
  • Ticlopidine / therapeutic use


  • Platelet Aggregation Inhibitors
  • Clopidogrel
  • Ticlopidine
  • Aspirin