2018 update of expert consensus statement on antiplatelet therapy in East Asian patients with ACS or undergoing PCI

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

“…East Asians have shown a lower incidence of ischemic heart disease and a decreased risk of post-PCI atherothrombotic complications compared with Caucasians. 2,4,5,7,24 Difference in hypercoagulability may be a crucial factor to account for the "East Asian Paradox" (e.g., low coagulation and inflammation in East Asians). 1,3,25 Most common single-point mutations related with inherited thrombophilia are factor V Leiden and prothrombin G20210A, which have been related with the prevalence of CAD.…”

“…1). [1][2][3][4] Clinical experiences and the unique risk-benefit trade-off of East Asian population have urged clinicians to prescribe different antithrombotic regimens and reduced doses of antithrombotic agents in patients with cardiovascular disease (CVD).…”

The Effect of Low-Dose Ticagrelor on Platelet Function Profiles in Patients With Stable Coronary Artery Disease in Trinidad: The TWIST Pilot Study

“…Of note, in Japan, other widely used oral P2Y 12 receptor antagonists such as clopidogrel and prasugrel have been approved at lower doses than the doses approved worldwide based on pharmacokinetic (PK) and PD studies of these agents [ 24 ]. Overall, it has been suggested that East Asians appear to possess a contrasting therapeutic window for platelet reactivity, as they tend to display HPR after antiplatelet agents with respective lower thrombotic events, dubbed the “East Asian paradox” [ 25 , 26 ]. The rationale for such differences is not fully elucidated; however, attributed to genetic, cellular, plasmatic, and inflammatory factors [ 27 ].…”

To drop or not to drop the antiplatelet agent, that is the question for patients with atrial fibrillation and chronic coronary syndrome undergoing percutaneous coronary intervention

“…Firstly, the OAC-ALONE and AFIRE trials were conducted only in Japan. It is acknowledged that East Asian patients treated with anti-thrombotics are more vulnerable to bleeding complications when compared with Caucasians ("East Asian Paradox") [8]. In addition, the occurrence of MI related with AF appeared low in East Asian vs. Caucasian patients.…”

“…In this issue of "Cardiology Journal", Franchina et al [9] report a case review of ST-segmentelevation myocardial infarction (STEMI) in AF patients with CCS beyond 1 year after PCI, in the context of various antithrombotic regimens (OAC monotherapy in 3 cases, discontinuation of OAC due to a planned prostate biopsy in 1 case, Table 1. Baseline characteristics and clinical outcomes in the OAC-ALONE and AFIRE trials [7,8]. combined OAC and SAPT in 1 case, and no antithrombotic therapy in 1 case).…”