Relationship between Aspirin Resistance and Gene Polymorphism in Chinese Patients with Cerebral Infarction: A Systematic Review and Meta-Analysis

Introduction Ischemic stroke, a major subtype of cerebral infarction, results from reduced blood flow to the brain and presents various neurological dysfunctions. Ischemic stroke incidence remains high both globally and in China. Due to its antiplatelet aggregation properties, aspirin is widely used and has been shown to reduce the risk of stroke. However, some patients develop Aspirin Resistance (AR), particularly after recurrent cerebral infarction. This study conducted a systematic review and meta-analysis to examine the association between genetic polymorphism and AR in ischemic stroke. Methods A comprehensive literature search was conducted from October to December 2024 using PubMed, Web of Science, and Embase to identify relevant studies on AR and genetic polymorphisms in Chinese populations. Eight studies, encompassing a total of 2,951 participants and published between 2014 and 2024, met the inclusion criteria. Results The meta-analysis identified five genetic polymorphisms that are significantly correlated with the resistance response of patients with cerebral infarction to aspirin: Cyclooxygenase-1 ( COX-1 ), Prostaglandin-Endoperoxide Synthase 1 ( PTGS1 ), Platelet Endothelial Aggregation Receptor 1 ( PEAR1 ), ATP-Binding Cassette Sub-familyB Member 1 ( ABCB1 ), and P2Y1 Receptor ( P2RY1 ). The overall Odds Ratio (OR) was 11.56 (95% CI: 2.45–54.62), p = 0.002, indicating a strong association between these polymorphisms and AR. OR refer to the allele contrast (dominant vs . wild-type model). Discussion This meta-analysis evaluated the association between genetic polymorphisms and AR in Chinese people, particularly those involving PEAR1, PTGS1, COX-1, ABCB1, and P2Y12 . Conclusion This systematic review and meta-analysis indicate that genetic polymorphisms - especially COX-1, PTGS1, PEAR1, P2Y1, and ABCB1 may play an important role in the development of AR and influence ischemic stroke outcomes in the Chinese population.