Philip Chang, MD
When your patient has a stroke while on an antiplatelet regimen, a common practice is to switch it. If they were on aspirin, change to clopidogrel. If on clopidogrel, one may think of switching to aspirin plus dipyridamole. While there has been much theory about aspirin failure, or aspirin resistance, there has been scant evidence to suggest that switching antiplatelet agents may benefit patients. Clinicians have switched antiplatelet regimens under the common philosophy, “Insanity is doing the same thing over and over again and expecting different results.” This is with the underlying theory that patients who experience recurrent stroke while on aspirin must have developed aspirin resistance, and blocking another antiplatelet pathway (like ADP) will confer some protective benefit. However, this theory has never been proven or disproven by a clinical study. This article by Lee et al is a great step into this clinical conundrum.