Keywords
laboratory resistance
ischemic stroke
atherosclerosis
secondary prevention
Abstract
Introduction. Atherosclerosis of a major cerebral artery is the main cause of atherothrombotic ischemic stroke. Platelets are actively involved in the pathogenesis of the formation and progression of an atherosclerotic plaque. Acetylsalicylic acid (ASA) is the main drug for secondary prevention of atherothrombotic ischemic stroke. ASA inhibits cyclooxygenase-1, which prevents the production of thromboxane A2, thereby inhibiting platelets. Effective antiplatelet therapy can significantly reduce the risk of recurrent acute ischemic stroke.
Aim of work is to identify clinical and genetic factors contributing to the development of laboratory resistance to ASA in patients with atherothrombotic ischemic stroke.
Materials and methods. In the Sverdlovsk Regional Clinical Hospital No. 1, 2 case histories of patients who had suffered atherothrombotic ischemic stroke were studied. To identify laboratory resistance, the method of optical aggregometry and a set of genes (ABCB1, CYP2C19*2, CYP2C19*3, CYP2C19*17, ITGA2, ITGB3, PAI-1) affecting the development of high residual platelet reactivity were used.
Results. Laboratory resistance was detected in patients 3 months after atherothrombotic ischemic stroke, on the background of regular ASA intake, using optical aggregometry. When analyzing anamnestic data, the development of high residual platelet reactivity could be influenced by the presence of tobacco smoking or obesity in patients. The influence of age and concomitant therapy was not revealed. Genetic studies revealed mutations in two genes (ABCB1, CYP2C19*2) in both patients, which could affect the development of laboratory resistance.
Conclusions. Increasing the effectiveness of secondary prevention after atherothrombotic stroke, including the formation of laboratory resistance to ASA therapy, depends on the development of high residual platelet reactivity. The study and identification of clinical and genetic risk factors that can affect the development of high residual platelet reactivity remains an important clinical task that requires further research.
Acknowledgements
The author expresses gratitude to Dr. Sci. (Med.), Prof. L. I. Volkova for her consultation on the article materials; to the doctors of the Clinical Laboratory Diagnostics Department of the Sverdlovsk Regional Clinical Hospital No. 1 (Ekaterinburg) for conducting optical aggregometry.
For citation
Batenkova TYu. Laboratory resistance to antiplatelet therapy as part of secondary prevention after atherothrombotic stroke in the early recovery period (on the example of clinical cases). USMU Medical Bulletin. 2025;10(4):e00190. (In Russ.). DOI: https://doi.org/10.52420/usmumb.10.4.e00190. EDN: https://elibrary.ru/DZVGBR.
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