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Clopidogrel Resistance in Patients With Ischemic Stroke: Current Insights, Risk Factors, and the Role of Platelet

Weihua Li1,2, Yan Zhao3, Mengchen Yu3

  • 1School of Pharmacy, Hubei University of Science and Technology, Xianning, Hubei Province, China.

Journal of Cardiovascular Pharmacology
|July 22, 2026
PubMed

Insights

Clopidogrel resistance affects ischemic stroke patients, impacting treatment efficacy. Platelet function testing may guide personalized strategies for better outcomes in secondary stroke prevention.

Area of Science:

  • Pharmacology and Neurology
  • Cardiovascular Medicine

Background:

  • Clopidogrel is vital for secondary ischemic stroke prevention.
  • Some patients exhibit clopidogrel resistance, leading to treatment failure and recurrent events.
  • Understanding clopidogrel metabolism and resistance factors is crucial for optimizing therapy.

Purpose of the Study:

  • To review current research on clopidogrel resistance in ischemic stroke patients.
  • To explore the prevalence, predictors, and impact of clopidogrel resistance.
  • To clarify the role of platelet function testing in guiding individualized treatment.

Main Methods:

  • Literature review synthesizing research on clopidogrel pharmacology, metabolism, and resistance.
  • Analysis of risk factors contributing to clopidogrel resistance.
  • Evaluation of the clinical application of platelet function testing in ischemic stroke.

Main Results:

  • Clopidogrel resistance is linked to variable active metabolite production.
  • Specific genetic and clinical factors influence clopidogrel response.
  • Platelet function testing shows potential for guiding antiplatelet therapy.

Conclusions:

  • Clopidogrel resistance poses a challenge in ischemic stroke secondary prevention.
  • Personalized treatment strategies, potentially guided by platelet function tests, are needed.
  • Further research is essential to refine precision medicine approaches for clopidogrel therapy.

Keywords:
clopidogrel resistancehigh on-treatment platelet reactivityischemic strokeplatelet function testingrisk factors

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