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The East Asian Paradox: An Updated Position Statement on the Challenges to the Current Antithrombotic Strategy in

Hyun Kuk Kim1, Udaya S Tantry2, Sidney C Smith3

  • 1Department of Cardiology, Chosun University Hospital, Gwangju, South Korea.

Thrombosis and Haemostasis
|November 10, 2020
PubMed

Insights

East Asian patients experience less anti-ischemic benefit and higher bleeding risk with antithrombotic therapies. This review updates evidence on P2Y12 inhibitors and anticoagulants for this population.

Area of Science:

  • Cardiology
  • Pharmacology
  • Clinical Medicine

Background:

  • East Asian patients exhibit distinct responses to antithrombotic therapies, with reduced efficacy and increased bleeding risk compared to Caucasian populations.
  • The widespread use of potent P2Y12 inhibitors and direct oral anticoagulants necessitates a closer examination of their risk-benefit profile in East Asian individuals.

Purpose of the Study:

  • To present updated evidence regarding antithrombotic treatment strategies in East Asian patients.
  • To discuss the unique risk-benefit considerations for antithrombotic therapies in this demographic.
  • To outline future research directions for optimizing antithrombotic care in East Asians.

Main Methods:

  • Literature review of recent studies on antithrombotic therapies in East Asian populations.
  • Analysis of clinical trial data focusing on efficacy and safety outcomes.
  • Synthesis of expert opinions and clinical guidelines.

Main Results:

  • Evidence suggests a differential response to P2Y12 inhibitors (e.g., ticagrelor, prasugrel) and direct oral anticoagulants in East Asians.
  • Specific genetic factors and metabolic pathways may contribute to altered drug responses.
  • Current data highlight a complex interplay between anti-ischemic benefits and bleeding risks.

Conclusions:

  • Antithrombotic therapy requires tailored approaches in East Asian patients due to population-specific risk-benefit profiles.
  • Further research is crucial to refine dosing, drug selection, and monitoring strategies.
  • Optimizing antithrombotic treatment is essential for improving cardiovascular outcomes in East Asians.

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