Submit Manuscript  

Article Details


Should Antithrombotic Treatment Strategies in East Asians Differ from Caucasians?

[ Vol. 16 , Issue. 5 ]

Author(s):

Jae S. Bae, Jong-Hwa Ahn, Udaya S. Tantry, Paul A. Gurbel and Young-Hoon Jeong*   Pages 459 - 476 ( 18 )

Abstract:


With over 1.5 billion people, East Asians are the most populous race in the world. Health status in this population is an important global issue. In the contemporary trials of antithrombotic treatment, East Asian patients have a lower risk for atherothrombotic diseases (especially, Coronary Artery Disease [CAD]) and a higher risk for bleeding (especially, gastrointestinal bleeding and hemorrhagic stroke). Despite these observations, antithrombotic treatment strategies in East Asian patients are mainly based on the American or European guidelines that are derived from randomized, controlled trials including mostly Caucasians. Despite a low response to clopidogrel, East Asian patients with CAD show a similar or even a lower rate of ischemic event occurrence and higher bleeding risk compared with Caucasian patients. The latter is referred to as the “East Asian Paradox”, suggesting a dissimilar therapeutic window for antiplatelet therapy than Caucasians. In addition, different net clinical benefits have been observed between the races with potent P2Y12 inhibitors that may be related to racial differences in pharmacokinetic and pharmacodynamic profiles. Furthermore, there is emerging concern regarding differences between East Asian vs. Western patients in pharmacodynamic and clinical efficacies of anticoagulant agents. We now summarize experimental and clinical evidence of the efficacy and safety of antithrombotic agents in the East Asian population. We suggest the concept of “race-tailored antithrombotic treatment” in CAD patients and/or in patients undergoing percutaneous coronary intervention.

Keywords:

East Asian, coronary artery disease, antithrombotic treatment, bleeding, pharmacokinetics, pharmacodynamics.

Affiliation:

Department of Internal Medicine, Gyeongsang National University, School of Medicine and Cardiovascular Center, Gyeongsang National University Changwon Hospital, Changwon, Department of Internal Medicine, Gyeongsang National University, School of Medicine and Cardiovascular Center, Gyeongsang National University Changwon Hospital, Changwon, Inova Center for Thrombosis Research and Drug Development, Inova Heart and Vascular Institute, Fairfax, Virginia, Inova Center for Thrombosis Research and Drug Development, Inova Heart and Vascular Institute, Fairfax, Virginia, Department of Internal Medicine, Gyeongsang National University, School of Medicine and Cardiovascular Center, Gyeongsang National University Changwon Hospital, Changwon

Graphical Abstract:



Read Full-Text article