Antiplatelet Resistance: A Review of Concepts, Mechanisms, and Implications for Management in Acute Ischemic Stroke and Transient Ischemic Attack
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- Kailash Krishnan
- Stroke Department of Acute Medicine Queen's Medical Centre Nottingham University Hospitals NHS Trust Nottingham UK
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- Thanh N. Nguyen
- Department of NeurologyRadiology, Boston Medical CenterBoston University Chobanian and Avedisian School of MedicineBoston MA United States
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- Jason P. Appleton
- Department of Stroke Queen Elizabeth Hospital University Hospitals of Birmingham NHS Trust Birmingham UK
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- Zhe Kang Law
- Department of Medicine National University of Malaysia Kuala Lumpur Malaysia
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- Mark Caulfied
- Department of Clinical Pharmacology and Precision Medicine NIHR Biomedical Research Centre Barts and the London School of Medicine and Dentistry Queen Mary University of London London UK
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- Claudia P. Cabrera
- Department of Clinical Pharmacology and Precision Medicine NIHR Biomedical Research Centre Barts and the London School of Medicine and Dentistry Queen Mary University of London London UK
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- Rob Lenthall
- Department of Neuroradiology Queen's Medical Centre, Nottingham University Hospitals NHS Trust Nottingham UK
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- David Hewson
- Department of Anaesthesia Queen's Medical Centre, Nottingham University Hospitals NHS Trust Nottingham UK
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- Timothy England
- Department of Stroke Royal Derby Hospital Derby UK
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- Norman McConachie
- Department of Neuroradiology Queen's Medical Centre, Nottingham University Hospitals NHS Trust Nottingham UK
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- Permesh Dhillon
- Department of Neuroradiology Queen's Medical Centre, Nottingham University Hospitals NHS Trust Nottingham UK
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- Luqman Malik
- Department of Neuroradiology Queen's Medical Centre, Nottingham University Hospitals NHS Trust Nottingham UK
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- Anna Podlasek
- Department of Neuroradiology Queen's Medical Centre, Nottingham University Hospitals NHS Trust Nottingham UK
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- Craig J. Smith
- Manchester Centre for Clinical Neurosciences Geoffrey Jefferson Brain Research Centre, Manchester Academic Health Science Centre, Salford Royal Hospital, Salford; Division of Cardiovascular Sciences, University of Manchester Manchester UK
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- Jesse Dawson
- Department of Stroke Queen Elizabeth Hospital Glasgow UK
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- Thompson G. Robinson
- Department of Cardiovascular Sciences University of Leicester Leicester UK
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- Nikola Sprigg
- Stroke Department of Acute Medicine Queen's Medical Centre Nottingham University Hospitals NHS Trust Nottingham UK
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- Martin A. James
- Department of Stroke Medicine Royal Devon and Exeter NHS Foundation Trust Exeter UK
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- Phil White
- Stroke Research Group, Institute of Neuroscience Newcastle University Newcastle Upon Tyne UK
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- Michael J.R. Desborough
- Department of Clinical Haematology Oxford University Hospitals NHS Foundation Trust Oxford UK
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- Joannes Hermans
- Department of Haematology Nottingham University Hospitals NHS Trust Nottingham UK
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- Philip M. Bath
- Stroke Department of Acute Medicine Queen's Medical Centre Nottingham University Hospitals NHS Trust Nottingham UK
Abstract
<jats:p xml:lang="en">Acute ischemic stroke is a leading cause of death and major disability worldwide. Approximately 50% of ischemic strokes are caused by atherothrombotic occlusion of the cerebral arteries, and antiplatelets are the mainstay of secondary stroke preventative treatment. Aspirin is beneficial if given early, and short‐term treatment using aspirin and clopidogrel is increasingly used for patients with intracranial atherosclerotic disease, minor stroke, and or transient ischemic attack. However, up to 50% of patients continue to have recurrent stroke and major vascular events, which may be partly attributable to resistance to aspirin and or clopidogrel. Although the precise mechanisms are unknown, clinical and genetic factors associated with bioavailability and binding to target receptors are implicated. This narrative review begins with the concept of aspirin and clopidogrel resistance in ischemic stroke and transient ischemic attack, potential mechanisms including genetic polymorphisms, and an overview of platelet function measures and limitations. We conclude by highlighting practical issues in the management of patients with aspirin andclopidogrel resistance including the emerging interest in ticagrelor, prasugrel, and cilostazol as well as directions for future trials in transient ischemic attack and acute ischemic stroke.</jats:p>
Journal
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- Stroke: Vascular and Interventional Neurology
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Stroke: Vascular and Interventional Neurology 3 (3), 2023-05
Ovid Technologies (Wolters Kluwer Health)
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Details 詳細情報について
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- CRID
- 1360016870539416576
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- ISSN
- 26945746
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- Data Source
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- Crossref