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Antithrombotic Strategy for Patients with Acute Coronary Syndrome: A Perspective from East Asia.
J Clin Med. 2020 Jun 23; 9(6)JC

Abstract

Dual antiplatelet therapy (DAPT) after percutaneous coronary intervention has become the standard of care, particularly in patients with acute coronary syndrome (ACS). Current clinical guidelines recommend novel P2Y12 inhibitors (e.g., prasugrel or ticagrelor) in addition to aspirin based on the results of representative randomized controlled trials conducted predominantly in Western countries. These agents were superior to clopidogrel in reducing the composite ischemic events, with a trade-off of the increased bleeding events. However, multiple differences exist between East Asian and Western patients, especially with respect to their physique, thrombogenicity, hemorrhagic diathesis, and on-treatment platelet reactivity. Recent studies from East Asian countries (e.g., Japan or South Korea) have consistently demonstrated that use of novel P2Y12 inhibitors is associated with a higher risk of bleeding events than use of clopidogrel, despite borderline statistical difference in the incidence of composite ischemic events. Additionally, multiple studies have shown that the optimal duration of DAPT may be shorter in East Asian than Western patients. This review summarizes clinical studies of antithrombotic strategies in East Asian patients with ACS. Understanding these differences in antithrombotic strategies including DAPT and their impacts on clinical outcomes will aid in selection of the optimal tailored antithrombotic therapy for patients with ACS.

Authors+Show Affiliations

Department of Cardiology, Japanese Red Cross Ashikaga Hospital, Ashikaga 326-0843, Japan.Department of Cardiology, Keio University School of Medicine, Tokyo 160-8582, Japan.Department of Cardiology, Keio University School of Medicine, Tokyo 160-8582, Japan.Department of Cardiovascular Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama 700-8558, Japan.Department of Medicine, Icahn School of Medicine at Mount Sinai, Mount Sinai Beth Israel, New York, NY 10003, USA.Department of Cardiology, Keio University School of Medicine, Tokyo 160-8582, Japan.Department of Cardiology, Keio University School of Medicine, Tokyo 160-8582, Japan.

Pub Type(s)

Journal Article
Review

Language

eng

PubMed ID

32585929

Citation

Numasawa, Yohei, et al. "Antithrombotic Strategy for Patients With Acute Coronary Syndrome: a Perspective From East Asia." Journal of Clinical Medicine, vol. 9, no. 6, 2020.
Numasawa Y, Sawano M, Fukuoka R, et al. Antithrombotic Strategy for Patients with Acute Coronary Syndrome: A Perspective from East Asia. J Clin Med. 2020;9(6).
Numasawa, Y., Sawano, M., Fukuoka, R., Ejiri, K., Kuno, T., Shoji, S., & Kohsaka, S. (2020). Antithrombotic Strategy for Patients with Acute Coronary Syndrome: A Perspective from East Asia. Journal of Clinical Medicine, 9(6). https://doi.org/10.3390/jcm9061963
Numasawa Y, et al. Antithrombotic Strategy for Patients With Acute Coronary Syndrome: a Perspective From East Asia. J Clin Med. 2020 Jun 23;9(6) PubMed PMID: 32585929.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Antithrombotic Strategy for Patients with Acute Coronary Syndrome: A Perspective from East Asia. AU - Numasawa,Yohei, AU - Sawano,Mitsuaki, AU - Fukuoka,Ryoma, AU - Ejiri,Kentaro, AU - Kuno,Toshiki, AU - Shoji,Satoshi, AU - Kohsaka,Shun, Y1 - 2020/06/23/ PY - 2020/05/29/received PY - 2020/06/14/revised PY - 2020/06/18/accepted PY - 2020/6/27/entrez PY - 2020/6/27/pubmed PY - 2020/6/27/medline KW - P2Y12 inhibition KW - acute coronary syndrome KW - dual antiplatelet therapy KW - percutaneous coronary intervention KW - tailored therapy JF - Journal of clinical medicine JO - J Clin Med VL - 9 IS - 6 N2 - Dual antiplatelet therapy (DAPT) after percutaneous coronary intervention has become the standard of care, particularly in patients with acute coronary syndrome (ACS). Current clinical guidelines recommend novel P2Y12 inhibitors (e.g., prasugrel or ticagrelor) in addition to aspirin based on the results of representative randomized controlled trials conducted predominantly in Western countries. These agents were superior to clopidogrel in reducing the composite ischemic events, with a trade-off of the increased bleeding events. However, multiple differences exist between East Asian and Western patients, especially with respect to their physique, thrombogenicity, hemorrhagic diathesis, and on-treatment platelet reactivity. Recent studies from East Asian countries (e.g., Japan or South Korea) have consistently demonstrated that use of novel P2Y12 inhibitors is associated with a higher risk of bleeding events than use of clopidogrel, despite borderline statistical difference in the incidence of composite ischemic events. Additionally, multiple studies have shown that the optimal duration of DAPT may be shorter in East Asian than Western patients. This review summarizes clinical studies of antithrombotic strategies in East Asian patients with ACS. Understanding these differences in antithrombotic strategies including DAPT and their impacts on clinical outcomes will aid in selection of the optimal tailored antithrombotic therapy for patients with ACS. SN - 2077-0383 UR - https://www.unboundmedicine.com/medline/citation/32585929/Antithrombotic_Strategy_for_Patients_with_Acute_Coronary_Syndrome:_A_Perspective_from_East_Asia L2 - https://www.mdpi.com/resolver?pii=jcm9061963 DB - PRIME DP - Unbound Medicine ER -
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