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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\u00a0directions for future trials in transient ischemic attack and acute ischemic stroke.<\/jats:p>","DOI":"10.1161\/svin.122.000576","type":"journal-article","created":{"date-parts":[[2023,1,28]],"date-time":"2023-01-28T02:22:46Z","timestamp":1674872566000},"update-policy":"https:\/\/doi.org\/10.1161\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":36,"title":["Antiplatelet Resistance: A Review of Concepts, Mechanisms, and Implications for Management in Acute Ischemic Stroke and Transient Ischemic Attack"],"prefix":"10.1161","volume":"3","author":[{"given":"Kailash","family":"Krishnan","sequence":"first","affiliation":[{"name":"Nottingham University Hospitals NHS Trust","place":["Nottingham, UK"]},{"name":"University of Nottingham","place":["Nottingham, UK"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2810-1685","authenticated-orcid":false,"given":"Thanh N.","family":"Nguyen","sequence":"additional","affiliation":[{"name":"Boston University Chobanian and Avedisian School of Medicine","place":["Boston, United\u00a0States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jason P.","family":"Appleton","sequence":"additional","affiliation":[{"name":"Queen Elizabeth Hospital","place":["UK"]},{"name":"University Hospitals of Birmingham NHS Trust","place":["UK"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zhe Kang","family":"Law","sequence":"additional","affiliation":[{"name":"National University of Malaysia","place":["Kuala Lumpur, Malaysia"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mark","family":"Caulfied","sequence":"additional","affiliation":[{"name":"NIHR Biomedical Research Centre","place":["London, UK"]},{"name":"Barts and the London School of Medicine and Dentistry","place":["London, UK"]},{"name":"Queen Mary University of London","place":["London, UK"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Claudia P.","family":"Cabrera","sequence":"additional","affiliation":[{"name":"NIHR Biomedical Research Centre","place":["London, UK"]},{"name":"Barts and the London School of Medicine and Dentistry","place":["London, UK"]},{"name":"Queen Mary University of London","place":["London, UK"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rob","family":"Lenthall","sequence":"additional","affiliation":[{"name":"Queen's Medical Centre, Nottingham University Hospitals NHS Trust","place":["Nottingham, UK"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David","family":"Hewson","sequence":"additional","affiliation":[{"name":"Queen's Medical Centre, Nottingham University Hospitals NHS Trust","place":["Nottingham, UK"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Timothy","family":"England","sequence":"additional","affiliation":[{"name":"Royal Derby Hospital","place":["UK"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Norman","family":"McConachie","sequence":"additional","affiliation":[{"name":"Queen's Medical Centre, Nottingham University Hospitals NHS Trust","place":["Nottingham, UK"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Permesh","family":"Dhillon","sequence":"additional","affiliation":[{"name":"Queen's Medical Centre, Nottingham University Hospitals NHS Trust","place":["Nottingham, UK"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Luqman","family":"Malik","sequence":"additional","affiliation":[{"name":"Queen's Medical Centre, Nottingham University Hospitals NHS Trust","place":["Nottingham, UK"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anna","family":"Podlasek","sequence":"additional","affiliation":[{"name":"Queen's Medical Centre, Nottingham University Hospitals NHS Trust","place":["Nottingham, UK"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Craig J.","family":"Smith","sequence":"additional","affiliation":[{"name":"Geoffrey Jefferson Brain Research Centre, Manchester Academic Health Science Centre, Salford Royal Hospital, Salford; 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