What is your approach to a patient who has an ischemic stroke while on clopidogrel despite strict compliance and normal results on clopidogrel response assay?

Not all recurrent infarcts are from a failure of anti-thrombotics, some patients with large artery atherosclerosis are not taking their statin (as evidenced by no change in LDL-C) or are not exercising (based on subanalysis of SAMMPRIS), other lacunar subtype patients have uncontrolled hypertension,...

Agree with the above. I would add that it is important to ensure a careful stroke history and workup has been completed, the correct stroke mechanism identified, and that clopidogrel is the best therapy. I recently saw a patient in clinic for a recurrent stroke while on clopidogrel despite strict co...

I agree with all of the above responses.

I don't think there is any study with outcome data of stroke prevention by selecting antiplatelet therapy based on laboratory testing of antiplatelet activity or genetics. Neither are there data to support switching antiplatelet therapy based on stroke occurre...

If a patient is a 'plavix responder', and stroke recurrence is small vessel in appearance and presumed etiology, I typically will not change medications to an alternate antiplatelet unless the patient feels very uneasy about remaining on plavix. Patients with small vessel disease are at risk for rec...

Can always consider adding cilostazol to the clopidogrel. While not level 1 type recommendation, there's pretty good data to support it:

de Havenon et al., PMID 34517768