World Heart Federation expert consensus statement on antiplatelet therapy in East Asian patients with ACS or undergoing PCI

Levine, Glenn N.; Jeong, Young Hoon; Goto, Shinya; Anderson, Jeffrey L.; Huo, Yong; Mega, Jessica L.; Taubert, Kathryn A.; Smith, Sidney C.

doi:10.1038/nrcardio.2014.104

Cited by 292 publications

(209 citation statements)

References 72 publications

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“…27 Genetic polymorphisms might partially account for the underlying mechanism of differing bleeding risk with ethnicity. 28 In addition, we found that the CRUSADE and ACTION risk scores had greater predictive value for major bleeding than the ACUITY-HORIZONS risk model.…”

Section: Discussionmentioning

confidence: 99%

Predictive Validity of CRUSADE, ACTION and ACUITY-HORIZONS Bleeding Risk Scores in Chinese Patients With ST-Segment Elevation Myocardial Infarction

Liu

Zheng

Zhao

et al. 2018

Circ J

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Background:The CRUSADE, ACTION and ACUITY-HORIZONS bleeding scores have been derived using Caucasian patients, and little is known about which has the better predictive ability in Chinese patients, especially for patients with STEMI. Methods and Results:We retrospectively analyzed 2,208 consecutive STEMI patients undergoing primary PCI (PPCI). Major bleeding events were defined according to Bleeding Academic Research Consortium criteria (type 3 or 5). Predictive ability of the 3 scores was assessed using logistic regression and AUC. Unadjusted HR for 1-year death were determined on Cox proportional hazard modeling. The major bleeding rate was 2.4%. The AUC of the CRUSADE, ACTION and ACUTIY-HORIZONS models was 0.88 (95% CI: 0.84-0.92), 0.90 (95% CI: 0.87-0.94), and 0.78 (95% CI: 0.87-0.94). The calibration of the ACUTIY-HORIZONS model was not acceptable overall, or in the subgroup of access site (P<0.05). In the high-risk category, 1-year mortality was approximately 4-7-fold greater than in the low-risk category (CRUSADE: HR, 7.27; 95% CI: 3.30-16.02, P<0.001; ACTION: HR, 7.13; 95% CI: 2.19-15.41, P<0.001; ACUITY-HORIZONS: HR, 4.06; 95% CI: 1.62-10.16; P=0.003). Conclusions:The CRUSADE and ACTION scores have greater predictive ability for in-hospital major bleeding than the ACUITY-HORIZONS risk score in Chinese STEMI patients undergoing PPCI. Mortality would increase with the transition from low-to high-risk category in 1 year.

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Section: Discussionmentioning

confidence: 99%

Predictive Validity of CRUSADE, ACTION and ACUITY-HORIZONS Bleeding Risk Scores in Chinese Patients With ST-Segment Elevation Myocardial Infarction

Liu

Zheng

Zhao

et al. 2018

Circ J

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“…East Asian patients, despite a higher prevalence of clopidogrel resistance, seem to have a lower rate of ischemic events after DES implantation than Western patients, suggesting ethnic differences in the response to DAPT. 53 The maintenance dose of P2Y12 receptor blockers was determined from clinical trials conducted mostly in Caucasian populations. East Asians may require a lower dose of P2Y12 receptor blockers for similar protection from ischemic events.…”

Section: Ethnic Differencesmentioning

confidence: 99%

Dual Antiplatelet Therapy for Coronary Artery Disease

Lee

2015

Circ J

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Circulation Journal Official Journal of the Japanese Circulation Society http://www. j-circ.or.jp thrombi, and are activated when the vascular endothelium is damaged. Platelet activation can be triggered by many different agonists, including adenosine diphosphate, thromboxane A2, thrombin, etc. Adenosine diphosphate, as a P2Y12 receptor agonist, induces platelet degranulation and shape change, leading to amplification and stabilization of platelet aggregation. 8 The central role of the P2Y12 receptor in platelet activation has made it a key target of antiplatelet agents. Ticlopidine, a firstgeneration thienopyridine, was discovered in 1972 and introduced as an antiplatelet agent in 1978. Despite its excellent antiplatelet effect, ticlopidine has rare but potentially fatal side effects, including aplastic anemia, neutropenia and thrombotic thrombocytopenic purpura, requiring routine hematological monitoring. 9 Clopidogrel is a second-generation thienopyridine lacking the serious hematological side effects of ticlopidine and was approved for use in 1997. Clopidogrel has quickly replaced ticlopidine because of its equivalent efficacy and superior safety profile. P2Y12 receptor blocker development led to prasugrel and ticagrelor, which overcome the limitations of clopidogrel, such as delayed onset of action and high interindividual variability of antiplatelet response. 10 Prasugrel is a third-generation thienopyridine with faster onset of action and less interindividual variability. It is more efficiently converted to an active metabolite than first-and second-generation thienopyridines. Thienopyridine derivatives exert their antiplatelet activity by irreversibly inhibiting the P2Y12 receptor. By contrast, ticagrelor is a new chemical class with faster onset of action and consistent platelet inhibition that does not require hepatic metabolism for its activity and causes reversible inhispirin prevents serious vascular events in patients at high risk of atherosclerosis. 1,2 The mechanism of aspirin's antiplatelet action was first described in 1971, 3 but it took a long time before aspirin's value was accepted in cardiovascular medicine. Early aspirin trials were mostly of questionable statistical significance. Moreover, the first large randomized trial, the Aspirin Myocardial Infarction Study (AMIS), showed that aspirin (1,000 mg/day) did not prevent cardiac death in patients who had already had a myocardial infarction (MI). 4 Adverse side effects, including peptic ulcer and gastrointestinal bleeding, were higher in the aspirin group than in the placebo group. Based on the AMIS results, aspirin was not routinely recommended for patients who had survived a MI. In the large, randomized International Study of Infarct Survival (ISIS)-2, however, aspirin (160 mg/day) demonstrated a dramatic 23% reduction in vascular mortality compared with placebo in patients with acute MI. 5 Thereafter, the use of aspirin in real-world clinical practice rapidly increased in advance of controlled studies, reflecting the ISIS-2 trial's stro...

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“…14, 15 Age and body weight may also differ on average from Caucasian populations, knowing that in the FEATHER trial 16 5 mg prasugrel in low body weight patients provided a similar level of platelet inhibition to 10 mg prasugrel in higher body weight patients. The Asian population also displays a higher PD response to prasugrel and ticagrelor with higher exposure to the active metabolite than do Caucasians, 17 suggesting that these drugs are not suitable at the standard dose regimens.…”

mentioning

confidence: 99%