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with hemihypesthesia&#46; The neuroimaging tests revealed a new ischemic lesion in the left internal capsule&#46; What should our clinical approach be with this patient&#63;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0030">Resistance to aspirin</span><p id="par0010" class="elsevierStylePara elsevierViewall">Antiplatelet therapy&#44; in particular ASA&#44; constitutes one of the cornerstones of cardiovascular &#40;CV&#41; medicine&#46; Despite its demonstrated efficacy&#44; many patients who take this medication continue to experience adverse CV episodes&#46; In daily clinical practice&#44; we often see patients who are on ASA therapy for having experienced an ischemic stroke and who complain of a new cerebrovascular episode&#46; In fact&#44; in the United States alone&#44; approximately 185&#44;000 recurrent strokes occur every year&#44; and between a third and a half of these occur in patients who are in some type of antiplatelet therapy&#46;<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">The onset of thrombotic phenomena in patients treated with ASA lead to the use of the term &#8220;aspirin resistance&#8221;&#46; ASA resistance has been the subject of debate since the 1980s&#46; However&#44; it was not until the following decade in 1993 when Helgason first used the concept of &#8220;aspirin resistance&#8221;&#44; specifically in subjects with stroke&#46;<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">We currently know that&#44; given the multifactorial nature of atherothrombosis&#44; only 25&#37; of major CV complications &#40;myocardial infarction&#44; stroke and vascular death&#41; can be avoided through the use of aspirin&#46;<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> If we refer in particular to cerebrovascular disease&#44; the relative risk reduction is 13&#37;&#46;<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a></p><p id="par0025" class="elsevierStylePara elsevierViewall">The antithrombotic effect of ASA is due to a reduction in platelet activation&#44; mainly by the irreversible acetylation of the cyclooxygenase enzyme 1 &#40;COX-1&#41; using the acetylation of its residue serine-529&#44; thereby impeding the synthesis of thromboxane A2 &#40;TXA2&#41;&#44; the most important trigger for platelet activation&#46;<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a> However&#44; other mechanisms are also involved&#46; Although the serum peak is reached in approximately 1<span class="elsevierStyleHsp" style=""></span>h after a single dose of ASA and then decreases rapidly&#44; COX-1 platelet activity is completely inhibited and lasts over the useful lifetime of the platelet &#40;7&#8211;10 days&#41;&#46; The COX-1 inhibition recovers by approximately 10&#37; a day due to the release of new platelets into the circulation&#46; Therefore&#44; the effects of ASA are maintained with daily dosages intervals&#46;<a class="elsevierStyleCrossRefs" href="#bib0015"><span class="elsevierStyleSup">3&#44;5</span></a></p><p id="par0030" class="elsevierStylePara elsevierViewall">The term &#8220;aspirin resistance&#8221; has been used to describe various phenomena&#44; one of which is known as clinical resistance or failure to prevent clinical events&#44; that is&#44; the onset of thromboembolic CV events despite ongoing treatment with ASA at therapeutic dosages&#44; which is also known as &#8220;treatment failure&#8221;&#46; This is a common phenomenon given that ASA inhibits only one platelet aggregation pathway&#44; and this is not the only pathophysiological mechanism in the formation of thrombi&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">The second concept is the laboratory&#44; functional or biochemical resistance or inability of ASA to inhibit COX-1 and thereby the TXA2-dependent platelet functions&#46; These functions are measured in vivo by bleeding time and TXA2 levels and in vitro by various aggregation methods&#46;</p><p id="par0040" class="elsevierStylePara elsevierViewall"><a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a> lists the various laboratory methods for assessing ASA resistance&#46;<a class="elsevierStyleCrossRefs" href="#bib0025"><span class="elsevierStyleSup">5&#44;6</span></a></p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0045" class="elsevierStylePara elsevierViewall">The factors associated with the state of ASA resistance are numerous &#40;<a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>&#41;&#46; Of these&#44; treatment non-compliance is the most important&#46; At 1 year after starting ASA therapy&#44; approximately 50&#37; of patients are not taking the medication or are not adhering to the prescribed dosage&#46;<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">7</span></a></p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Importance of aspirin resistance in cerebrovascular disease</span><p id="par0050" class="elsevierStylePara elsevierViewall">There are dozens of studies and several meta-analyses that show that between 15&#37; and 25&#37; of individuals are ASA resistant&#46;<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">8</span></a> The largest meta-analysis performed&#44; which included 42 studies&#44; recorded an ASA resistance rate of 27&#37;&#46;<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">9</span></a> In the particular case of patients with stroke&#44; the presence of resistance varies significantly&#44; ranging from 3&#37; to 85&#37; of patients&#46;<a class="elsevierStyleCrossRefs" href="#bib0050"><span class="elsevierStyleSup">10&#44;11</span></a> A meta-analysis of 2930 patients with CV disease found that patients resistant to aspirin showed an increased risk of new CV events &#40;OR 3&#46;85&#59; 95&#37; CI&#58; 3&#46;08&#8211;4&#46;80&#59; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>&#46;001&#41;&#44; with an OR of new cerebrovascular events of 3&#46;78 and a greater likelihood of death &#40;OR 5&#46;99&#59; 95&#37; CI&#58; 2&#46;28&#8722;15&#46;72&#59; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>&#46;003&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">12</span></a></p><p id="par0055" class="elsevierStylePara elsevierViewall">ASA resistance is associated with a greater cerebral infarction area and is usually of greater clinical severity than in patients with acute stroke&#46;<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">13</span></a> There is a greater risk of recurring stroke and experiencing new vascular events&#46;<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">14</span></a> ASA resistance is also an independent predictor of short and long-term mortality&#46;<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">15</span></a></p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Areas of uncertainty</span><p id="par0060" class="elsevierStylePara elsevierViewall">Regarding ASA resistance in patients with recent stroke&#44; there are still many areas of uncertainty&#46; These are mainly concentrated into two issues that will determine the management of the patient&#58;</p><p id="par0065" class="elsevierStylePara elsevierViewall">Is the measurement of ASA resistance recommended in daily clinical practice&#63;</p><p id="par0070" class="elsevierStylePara elsevierViewall">If there is evidence of ASA resistance&#44; how can it be solved&#63;</p><p id="par0075" class="elsevierStylePara elsevierViewall">Currently and in particular with stroke&#44; we do not have studies that state that the monitoring of platelet function during antiplatelet therapy with platelet represents a relevant advantage in clinical practice&#46;</p><p id="par0080" class="elsevierStylePara elsevierViewall">According to the recommendations of the European Society of Cardiology &#40;ESC&#41;&#44; the study of ASA resistance could be conducted in academic centers with experience in platelet reactivity tests and in individual selected cases &#40;for example&#44; patients with multiple CV risk factors and recurrent thrombotic events&#44; such as patients with stent thrombosis&#44; once compliance with the antiplatelet dosage has been verified&#41;&#46; The lack of large-scale&#44; randomized trials means that the use of platelet function tests is not recommended in standard clinical practice&#46;<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">16</span></a></p><p id="par0085" class="elsevierStylePara elsevierViewall">Moreover&#44; the guidelines of the American College of Cardiology and the American Heart Association &#40;ACC&#47;AHA&#41; currently only recommend platelet function tests in patients at high risk for coronary stent thrombosis &#40;Class IIb&#44; Level of Evidence C&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">17</span></a></p><p id="par0090" class="elsevierStylePara elsevierViewall">However&#44; what do we do if&#44; as in our case&#44; the patient in ASA treatment experiences a stroke and we suspect that there is a phenomenon of ASA &#8220;resistance&#8221;&#63; The approach to follow is summarized in <a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0095" class="elsevierStylePara elsevierViewall">The first step should be an evaluation of therapeutic compliance assessing the onset of interactions &#40;for example&#44; taking Ibuprofen&#41;&#46; It should also be ruled out that the new ischemic episode is related to other causes not preventable with ASA&#44; such as unknown atrial fibrillation &#40;AF&#41; and significant carotid stenosis&#44; among others&#46;</p><p id="par0100" class="elsevierStylePara elsevierViewall">Otherwise&#44; there are several therapeutic possibilities&#46; Changing to anticoagulants is not an option&#46; This practice was abandoned almost a decade ago when the Warfarin-Aspirin Recurrent Stroke Study Group &#40;WARSS&#41;<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">18</span></a> found that warfarin offered no benefits over aspirin in the prevention of recurrent noncardioembolic ischemic stroke&#46;</p><p id="par0105" class="elsevierStylePara elsevierViewall">A first approach could be to increase the dose&#46; The platelet response to ASA seems to be dose-dependent&#59; higher doses &#40;300<span class="elsevierStyleHsp" style=""></span>mg instead of 100<span class="elsevierStyleHsp" style=""></span>mg&#41; are associated with lower resistance rates&#46;<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">19</span></a> However&#44; we know that different doses of ASA &#40;75&#8211;1500<span class="elsevierStyleHsp" style=""></span>mg&#41; provide similar benefits in the reduction of morbidity and mortality by CV disease and stroke&#46; In addition&#44; there is a clear dose&#8211;hemorrhage relationship for aspirin&#46;<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">11</span></a></p><p id="par0110" class="elsevierStylePara elsevierViewall">A second option would be to change the aspirin for another antiplatelet agent&#46; It is not currently known whether changing aspirin for clopidogrel in aspirin-resistant subjects is an effective strategy&#44; because many patients who do not respond to aspirin are also less &#8220;sensitive&#8221; to clopidogrel&#46;<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">20</span></a> In addition&#44; there are no clinical trials that indicate that changing antiplatelet agents reduces the risk of subsequent vascular events&#46;<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">13</span></a> The role of new antiplatelet agents&#44; such as prasugrel and ticargrelor&#44; has not yet been established in these patients&#46;</p><p id="par0115" class="elsevierStylePara elsevierViewall">A third pathway would be to combine clopidogrel with ASA&#46; A recent meta-analysis<a class="elsevierStyleCrossRef" href="#bib0105"><span class="elsevierStyleSup">21</span></a> on the effect of the combination of aspirin and clopidogrel in cardiovascular prevention in 48&#44;248 patients concluded that although the addition of aspirin to clopidogrel resulted in small reductions in CV events&#44; this was at the cost of increased hemorrhaging events&#46; In absolute terms&#44; the benefits of the combined therapy&#44; with a reduction of 1&#46;06&#37; &#40;95&#37; CI&#58; 0&#46;23&#8211;1&#46;99&#37;&#41; in major CV events&#44; do not compensate for the damage&#44; with an increase the 1&#46;23&#37; &#40;95&#37; CI&#58; 0&#46;52&#8211;2&#46;14&#37;&#41; in severe bleeding&#46;</p><p id="par0120" class="elsevierStylePara elsevierViewall">Regarding patients with prior strokes&#44; the 2004 MATCH &#40;Management of Atherothrombosis with Clopidogrel in High-Risk Patients with Recent Transient Ischemic Attacks or Ischemic Stroke&#41; study<a class="elsevierStyleCrossRef" href="#bib0110"><span class="elsevierStyleSup">22</span></a> demonstrated the lack of benefit of combining ASA and clopidogrel in subjects with stroke&#46; For 7599 patients with high cardiovascular risk who had experienced a TIA or ischemic stroke in the last 3 months&#44; the addition of aspirin to clopidogrel represented no clinical benefit and multiplied the risk of severe hemorrhaging by more than 2 &#40;2&#46;6&#37; vs&#46; 1&#46;3&#37;&#59; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>&#46;001&#41;&#46;</p><p id="par0125" class="elsevierStylePara elsevierViewall">The SPS3 &#40;Secondary Prevention of Small Subcortical Strokes&#41; study has been recently published&#46;<a class="elsevierStyleCrossRef" href="#bib0115"><span class="elsevierStyleSup">23</span></a> In a sample of 3020 patients with lacunar infarction&#44; the efficacy of ASA &#40;325<span class="elsevierStyleHsp" style=""></span>mg&#41; was compared to the same dosage combined with clopidogrel&#46; The double antiplatelet treatment did not lower the incidence of recurrent stroke and doubled the risk of hemorrhage &#40;HR 1&#46;97&#59; 95&#37; CI&#58; 1&#46;41&#8211;2&#46;71&#59; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>&#46;001&#41;&#46;</p><p id="par0130" class="elsevierStylePara elsevierViewall">A subsequent meta-analysis<a class="elsevierStyleCrossRef" href="#bib0120"><span class="elsevierStyleSup">24</span></a> of 90&#44;934 participants&#44; which included the SPS3 study&#44; analyzed the effect of the addition of ASA to clopidogrel on mortality&#46;<a class="elsevierStyleCrossRef" href="#bib0120"><span class="elsevierStyleSup">24</span></a> The combined therapy did not result in a significant increase in short or long-term mortality but was associated with an increase in fatal hemorrhages &#40;OR&#58; 1&#46;35&#59; 95&#37; CI&#58; 0&#46;97&#8211;1&#46;90&#41;&#46;</p><p id="par0135" class="elsevierStylePara elsevierViewall">Other authors have asserted that&#44; although the combination of clopidogrel and aspirin does not seem to be useful in the long term&#44; it could to be effective in the first moments of stroke&#44; as was recently shown by the CHANCE study&#46;<a class="elsevierStyleCrossRef" href="#bib0125"><span class="elsevierStyleSup">25</span></a> The double antiplatelet therapy with clopidogrel and aspirin was more effective than ASA in monotherapy after a TIA or lesser acute stroke&#44; decreasing the risk of suffering a new stroke by 32&#37;&#46;</p><p id="par0140" class="elsevierStylePara elsevierViewall">Nevertheless&#44; the current guidelines of the American Heart Association&#47;American Stroke Association &#40;AHA&#47;ASA&#41;<a class="elsevierStyleCrossRef" href="#bib0130"><span class="elsevierStyleSup">26</span></a> do not leave many options for therapy&#58; &#8220;<span class="elsevierStyleItalic">The addition of aspirin to clopidogrel increases the risk of hemorrhage and is not recommended for routine secondary prevention after ischemic stroke or TIA &#40;Class III&#44; Level of Evidence A&#41;</span>&#8221;&#46;</p><p id="par0145" class="elsevierStylePara elsevierViewall">&#8220;For patients who have an ischemic stroke while taking aspirin&#44; there is no evidence that increasing the dose of aspirin provides additional benefit&#46; Although alternative antiplatelet agents are often considered&#44; no single agent or combination has been studied in patients who have had an event while receiving aspirin &#40;Class IIb&#44; Level of Evidence C&#41;&#8221;&#46;</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Recommendations and conclusions</span><p id="par0150" class="elsevierStylePara elsevierViewall">Aspirin resistance in patients with stroke is a common phenomenon of considerable clinical importance&#44; given that these patients will have a higher risk of new stroke&#44; vascular events and increased mortality&#46;</p><p id="par0155" class="elsevierStylePara elsevierViewall">If a patient in treatment with ASA consults for a new ischemic stroke&#44; the most practical approach is to rule out the presence of &#8220;pseudoresistence&#8221; &#40;noncompliance&#44; taking drugs that interfere with the action of the ASA&#41; and other causes &#40;for example&#44; atrial fibrillation&#41;&#46; However&#44; even when these conditions have been ruled out&#44; there is currently no ideal solution&#46; A platelet function study is only indicated in selected cases&#46; Regarding treatment&#44; each case should be acted upon individually based on age&#44; type of stroke&#44; risk of bleeding&#44; coexistence of coronary artery disease and concomitant medication&#44; among others&#46;</p><p id="par0160" class="elsevierStylePara elsevierViewall">In the case of our patient&#44; it was shown that she had gone several months without taking aspirin&#59; the decision was therefore made to restart treatment with ASA at 300<span class="elsevierStyleHsp" style=""></span>mg&#47;day&#46;</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Conflicts of interest</span><p id="par0165" class="elsevierStylePara elsevierViewall">The authors declare that they have no conflicts of interest&#46;</p></span></span>"
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          "titulo" => "Resistance to aspirin"
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          "identificador" => "sec0015"
          "titulo" => "Importance of aspirin resistance in cerebrovascular disease"
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        7 => array:2 [
          "identificador" => "sec0020"
          "titulo" => "Areas of uncertainty"
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        8 => array:2 [
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          "titulo" => "Recommendations and conclusions"
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        9 => array:2 [
          "identificador" => "sec0030"
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    "fechaRecibido" => "2013-06-27"
    "fechaAceptado" => "2013-10-02"
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          "clase" => "keyword"
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          "palabras" => array:4 [
            0 => "Ischemic stroke"
            1 => "Aspirin resistance"
            2 => "Secondary prevention"
            3 => "Recurrent stroke"
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          "clase" => "keyword"
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          "palabras" => array:4 [
            0 => "Ictus isqu&#233;mico"
            1 => "Resistencia a aspirina"
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        "titulo" => "Abstract"
        "resumen" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Some patients with a recent ischemic stroke who are being treated with aspirin as an antiaggregant suffer a new ischemic stroke&#46; These patients &#40;15&#8211;25&#37;&#41; have been called unresponsive to aspirin or aspirin resistant&#46; The aspirin-resistant patients have a four-time greater risk of suffering a stroke&#46; Furthermore&#44; these strokes are generally more severe&#44; with increased infarct volume and greater risk of recurrence&#46; There is currently no ideal laboratory test to detect the resistance to the antiaggregant effect of aspirin&#46; The study of resistance to aspirin would only be indicated in selected cases&#46; In these patients&#44; one should first rule out any &#8220;pseudo-resistance&#8221; to aspirin &#40;lack of compliance&#44; concomitant treatments that interfere with the action of the aspirin&#41;&#46;</p>"
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        "resumen" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Algunos enfermos con ictus isqu&#233;mico reciente que siguen tratamiento con aspirina como antiagregante presentan un nuevo ictus isqu&#233;mico&#46; Estos pacientes han sido llamados &#171;resistentes&#187; o &#171;no respondedores a la aspirina&#187; &#40;15-25&#37;&#41;&#46; El riesgo de presentar un ictus es 4 veces mayor&#46; Adem&#225;s&#44; los ictus suelen ser m&#225;s graves&#44; con mayor &#225;rea infartada y con mayor riesgo de recurrencia&#46; Actualmente no existe una prueba de laboratorio ideal para detectar la resistencia al efecto antiagregante de la aspirina&#46; El estudio de resistencia a la aspirina solo estar&#237;a indicado en casos seleccionados y es obligado descartar la &#171;pseudorresistencia&#187; a la aspirina &#40;falta de cumplimiento&#44; tratamientos concomitantes que interfieren con la acci&#243;n de la aspirina&#41;&#46;</p>"
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        "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as&#58; Castilla-Guerra L&#44; Navas-Alc&#225;ntara MS&#44; Fern&#225;ndez-Moreno MC&#46; Resistencia a la aspirina en paciente con ictus isqu&#233;mico reciente&#46; Rev Clin Esp&#46; 2014&#58;214&#58;145&#8211;149&#46;</p>"
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          "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Management scheme for ASA resistance in patients with recent stroke&#46; Abbreviations&#58; ASA&#44; acetylsalicylic acid&#59; AF&#44; atrial fibrillation&#59; CV&#44; cardiovascular&#59; OAC&#44; oral anticoagulants&#46; &#42; For example&#58; With recurrent thrombotic events&#44; stent-carrying patients&#44; research studies&#46; &#42;&#42; Considering factors such as advanced age&#44; poorly controlled hypertension&#44; previous bleeding and concomitant medication&#46;</p>"
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          "en" => "<p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Main methods for monitoring platelet activity when managing ASA&#46;</p>"
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          "leyenda" => "<p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Abbreviations&#58; AA&#44; arachidonic acid&#59; ASA&#44; acetylsalicylic acid&#59; COX&#44; cyclooxygenase&#59; NSAIDs&#44; nonsteroidal anti-inflammatory drugs&#59; PPI&#44; proton pump inhibitor&#46;</p>"
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                0 => """
                  <table border="0" frame="\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">COX-1 dependent</span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>1&#46;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">Nonadherence to treatment&#46; The most common&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>2&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t">Reduced absorption of the drug&#46; pH conditions &#40;ideal 2&#8211;4&#41; Type of ASA &#40;coated&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>3&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">Interference with other drugs&#46; NSAIDs &#40;ibuprofen&#44; naproxen&#44; indomethacin&#41;&#44; PPI&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>4&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">High platelet turnover conditions&#46; Stress&#44; hemorrhage&#44; surgery&#44; acute ischemic syndromes&#44; acute or chronic infection&#47;inflammation&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>5&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">Genetic variants of COX-1&#46; Some 30&#37; of the response to antiplatelets is determined genetically&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="2" align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">COX-1 independent</span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>1&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">Increased platelet activation mediated by epinephrine or serotonin-catecholamines-collagen&#44; thrombin&#44; etc&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>2&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">COX-2 enzyme induction&#46; Inflammation and arteriosclerosis&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>3&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">Participation of others blood cells &#40;monocytes&#44; macrophages&#44; red blood cells&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>4&#46;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">Nonspecific lipid peroxidation of AA&#47;increased isoprostane production&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
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Journal Information
Vol. 214. Issue 3.
Pages 145-149 (April 2014)
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Vol. 214. Issue 3.
Pages 145-149 (April 2014)
Clinical up-date
Aspirin resistant patients with recent ischemic stroke
Resistencia a la aspirina en paciente con ictus isquémico reciente
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283
L. Castilla-Guerraa,
Corresponding author
castillafernandez@hotmail.com

Corresponding author.
, M.S. Navas-Alcántaraa, M.C. Fernández-Morenob
a Servicio de Medicina Interna, Hospital de la Merced, Osuna, Sevilla, Spain
b Servicio de Neurología, Hospital de Valme, Sevilla, Spain
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Table 1. Main methods for monitoring platelet activity when managing ASA.
Table 2. Mechanisms of ASA resistance.
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Abstract

Some patients with a recent ischemic stroke who are being treated with aspirin as an antiaggregant suffer a new ischemic stroke. These patients (15–25%) have been called unresponsive to aspirin or aspirin resistant. The aspirin-resistant patients have a four-time greater risk of suffering a stroke. Furthermore, these strokes are generally more severe, with increased infarct volume and greater risk of recurrence. There is currently no ideal laboratory test to detect the resistance to the antiaggregant effect of aspirin. The study of resistance to aspirin would only be indicated in selected cases. In these patients, one should first rule out any “pseudo-resistance” to aspirin (lack of compliance, concomitant treatments that interfere with the action of the aspirin).

Keywords:
Ischemic stroke
Aspirin resistance
Secondary prevention
Recurrent stroke
Resumen

Algunos enfermos con ictus isquémico reciente que siguen tratamiento con aspirina como antiagregante presentan un nuevo ictus isquémico. Estos pacientes han sido llamados «resistentes» o «no respondedores a la aspirina» (15-25%). El riesgo de presentar un ictus es 4 veces mayor. Además, los ictus suelen ser más graves, con mayor área infartada y con mayor riesgo de recurrencia. Actualmente no existe una prueba de laboratorio ideal para detectar la resistencia al efecto antiagregante de la aspirina. El estudio de resistencia a la aspirina solo estaría indicado en casos seleccionados y es obligado descartar la «pseudorresistencia» a la aspirina (falta de cumplimiento, tratamientos concomitantes que interfieren con la acción de la aspirina).

Palabras clave:
Ictus isquémico
Resistencia a aspirina
Prevención secundaria
Ictus recurrente

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From Monday to Friday from 9 a.m. to 6 p.m. (GMT + 1) except for the months of July and August which will be from 9 a.m. to 3 p.m.
Calls from Spain
932 415 960
Calls from outside Spain
+34 932 415 960
Email
Idiomas
Revista Clínica Española (English Edition)
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¿Es usted profesional sanitario apto para prescribir o dispensar medicamentos?

Are you a health professional able to prescribe or dispense drugs?