Antithrombotic Therapy After Acute Coronary Syndromes or Percutaneous Coronary Interventions in East Asian Populations

Kwon, Osung; Park, Duk‐Woo

doi:10.1016/j.jacasi.2021.12.005

Cited by 30 publications

(21 citation statements)

References 96 publications

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“…Thromboembolism is when a blood clot, usually formed in large deep veins in the leg or in a fibrillating atrium, breaks loose, possibly due to movement, is carried away in the blood flow, and occludes smaller downstream vessels, usually in the lungs or in the brain, causing deadly, paralyzing infarctions ( Feller et al, 2022 ). In the clinical context, the biomechanical properties of thrombi are determining factors for the prevention of thromboembolic diseases and for improving the efficiency of treatments such as endovascular thrombectomy ( Boodt et al, 2021 ; Kwon and Park, 2022 ). Despite the underlying therapeutic potential, the biomechanics of fibrin polymers have been insufficiently investigated.…”

Section: Single-molecule Studies Of Cardiovascular Diseasesmentioning

confidence: 99%

Application of optical tweezers in cardiovascular research: More than just a measuring tool

Yang

Zhu

et al. 2022

Front. Bioeng. Biotechnol.

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Recent advances in the field of optical tweezer technology have shown intriguing potential for applications in cardiovascular medicine, bringing this laboratory nanomechanical instrument into the spotlight of translational medicine. This article summarizes cardiovascular system findings generated using optical tweezers, including not only rigorous nanomechanical measurements but also multifunctional manipulation of biologically active molecules such as myosin and actin, of cells such as red blood cells and cardiomyocytes, of subcellular organelles, and of microvessels in vivo. The implications of these findings in the diagnosis and treatment of diseases, as well as potential perspectives that could also benefit from this tool, are also discussed.

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Section: Single-molecule Studies Of Cardiovascular Diseasesmentioning

confidence: 99%

Application of optical tweezers in cardiovascular research: More than just a measuring tool

Yang

Zhu

et al. 2022

Front. Bioeng. Biotechnol.

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“…While these studies in European and East Asian ancestry populations identified other potential genetic variants that may contribute to variation in clopidogrel response ( 31 , 63 – 66 ), they collectively demonstrate that CYP2C19 no function alleles are the strongest genetic determinant of clopidogrel response and associated with clopidogrel clinical effectiveness in European and East Asian ACS/PCI patients ( 13 , 26 ). Interestingly, East Asian populations are less likely to experience thromboembolic and ischemic complications but more likely to experience bleeding complications compared to European populations, which is known as the “East Asian Paradox” ( 67 ). It remains unclear whether genetic determinants of platelet function or antiplatelet drug effects underlie this effect, and thus additional genetic discovery research beyond CYP2C19 is needed.…”

Section: Racial and Ethnic Disparities In Discovery Studies That Iden...mentioning

confidence: 99%

Evaluation of race and ethnicity disparities in outcome studies of CYP2C19 genotype-guided antiplatelet therapy

Nguyen

Cavallari

Rossi

et al. 2022

Front. Cardiovasc. Med.

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Dual antiplatelet therapy with a P2Y12 inhibitor (clopidogrel, prasugrel, or ticagrelor) and aspirin remains the standard of care for all patients undergoing percutaneous coronary intervention (PCI). It is well-established that patients carrying CYP2C19 no function alleles have impaired capacity to convert clopidogrel into its active metabolite and thus, are at higher risk of major adverse cardiovascular events (MACE). The metabolism and clinical effectiveness of prasugrel and ticagrelor are not affected by CYP2C19 genotype, and accumulating evidence from multiple randomized and observational studies demonstrates that CYP2C19 genotype-guided antiplatelet therapy following PCI improves clinical outcomes. However, most antiplatelet pharmacogenomic outcome studies to date have lacked racial and ethnic diversity. In this review, we will (1) summarize current guideline recommendations and clinical outcome evidence related to CYP2C19 genotype-guided antiplatelet therapy, (2) evaluate the presence of potential racial and ethnic disparities in the major outcome studies supporting current genotype-guided antiplatelet therapy recommendations, and (3) identify remaining knowledge gaps and future research directions necessary to advance implementation of this precision medicine strategy for dual antiplatelet therapy in diverse, real-world clinical settings.

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“…These findings call for caution for such an early drop of aspirin among ACS patients undergoing unguided use of clopidogrel monotherapy. It is important to note that all the RCTs conducted in this setting, including STOPDAPT-2-ACS enrolled East Asians, a population with lower ischemic and greater bleeding events compared to other ethnicities ( 33 ). Therefore such an increase of ischemic events may underestimate the potential for ischemic events in Westerners and requires further investigations among populations of different ethnicities.…”

Section: De-escalation: How?mentioning

confidence: 99%

“…It is important to note that the effectiveness of a de-escalation strategy may be influenced by a number of factors that should be taken into account when adopting such a strategy. Indeed, clinical, demographics and sex-related characteristics may significantly impact the response to antiplatelets ( 33 ). In particular, Asian patients have been shown to be more susceptible to bleeding rather than ischemic events compared with Caucasian patients, despite CYP2C19 LoF alleles being more frequent in Asian ancestry population, a condition known as the “Asian paradox” ( 33 ).…”

Section: De-escalation: When?mentioning

confidence: 99%

“…Indeed, clinical, demographics and sex-related characteristics may significantly impact the response to antiplatelets ( 33 ). In particular, Asian patients have been shown to be more susceptible to bleeding rather than ischemic events compared with Caucasian patients, despite CYP2C19 LoF alleles being more frequent in Asian ancestry population, a condition known as the “Asian paradox” ( 33 ). Furthermore, recent data suggest woman may benefit the most from a de-escalation strategy consisting in P2Y 12 inhibitor monotherapy after a short course of DAPT suggesting the need for understanding potential sex-specific response to antiplatelet therapy ( 56 ).…”

Section: De-escalation: When?mentioning

confidence: 99%

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De-escalation of antiplatelet therapy in acute coronary syndromes: Why, how and when?

Galli

Angiolillo

2022

Front. Cardiovasc. Med.

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The synergistic blockade of the key platelet signaling pathways of cyclooxygenase-1 blockade and P2Y12 signaling by combining aspirin plus a potent P2Y12 inhibitor (prasugrel or ticagrelor), the so called dual antiplatelet treatment (DAPT), has represented the antithrombotic regimen of choice in patients with acute coronary syndrome (ACS) for nearly a decade. Nevertheless, the use of such antiplatelet treatment regimen, while reduced the risk of thrombotic complications, it is inevitably associated with increased bleeding and this risk may outweigh the benefit of a reduction of ischemic events in specific subgroup of patients. In light of the adverse prognostic implications of a bleeding complication, there has been a great interest in the development of antiplatelet regimens aimed at reducing bleeding without any trade-off in ischemic events. The fact that the ischemic risk is highest in the early phase after an ACS while the risk of bleeding remains relatively stable over time has represented the rationale for the implementation of a more intense antithrombotic regimen early after an ACS, followed by a less intense antithrombotic regimen thereafter. This practice, known as a “de-escalation” strategy, represents one of the more promising approaches for personalization of antithrombotic therapy in ACS. In this review we discuss the rationale, appraise the evidence and provide practical recommendations on the use of a de-escalation strategy of antiplatelet therapy in patients with an ACS.

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Antithrombotic Therapy After Acute Coronary Syndromes or Percutaneous Coronary Interventions in East Asian Populations

Cited by 30 publications

References 96 publications

Application of optical tweezers in cardiovascular research: More than just a measuring tool

Application of optical tweezers in cardiovascular research: More than just a measuring tool

Evaluation of race and ethnicity disparities in outcome studies of CYP2C19 genotype-guided antiplatelet therapy

De-escalation of antiplatelet therapy in acute coronary syndromes: Why, how and when?

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