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Purpose: The aim of the study was to review the current data from the literature on resistance to acetylsalicylic acid in patients with ischemic stroke, in particular its incidence, etiological mechanisms, diagnostic tests, its impact on the prognosis for patients who have suffered the stroke and the use of alternative antiplatelet therapies. Views: Acetylsalicylic acid is the most commonly used antiplatelet drug in the treatment and prophylaxis of patients with a diagnosis of ischemic stroke. It inhibits the activation and aggregation of platelets, playing an important role in the etiopathogenesis of  ischemic stroke. In many patients, the reduced sensitivity of platelets to acetylsalicylic acid contributes to the  ineffectiveness of the treatment. Platelet reactivity tests allow for the estimation of the laboratory resistance to aspirin and determine its impact on the prognosis of patients with ischemic stroke. Conclusions: The incidence of resistance to acetylsalicylic acid is common (5-65%) and has a complex, multifactorial aetiology, which significantly inhibits its therapeutic effect. Aspirin resistance worsens the ischemic stroke patients’ prognosis, both early and long-term, as has a negative impact on their clinical and functional status, mortality, size of ischemic focus and also for the tendency towards the recurrence of cerebrovascular incidents. Alternative therapies are recommended for patients with resistance to acetylsalicylic acid. Further research is required so as to enable aspirin-resistant patients to take advantage of optimized antiplatelet treatment, the effectiveness of which is a priority among this group of patients.

The role of resistance to acetylsalicylic acid in patients with ischemic stroke