Safety and effectiveness of the new P2Y12r inhibitor agents vs clopidogrel in ACS patients according to the geographic area: East Asia vs Europe

Systematic review with meta‐analysis: the risk of gastrointestinal bleeding in patients taking third‐generation P2Y12 inhibitors compared with clopidogrel

“…An analysis of the National inpatient sample database of the USA showed that Asian ethnicity was an independent predictor for major bleeding in patients with ST‐segment elevation myocardial infarction (STEMI) . However, study also reported that patients in East Asian countries have a lower rate of in‐hospital bleeding than European patients taking new P2Y 12 inhibitors agents (4% vs 8%, P < 0.001), but no difference was found at 1 year . In a retrospective analysis of PLATO, there was no significant difference in the risk of major bleeding between ticagrelor and clopidogrel users as well as between Asians and non‐Asians .…”

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

“…Based on the East Asian data from the latest analysis and registries, ticagrelor may not show definite advantages in reducing CV events over clopidogrel, but may increase the risk of bleeding and dyspnea. Moreover, the recent registry data showed that clopidogrel was more often prescribed to patients with more CV complications and higher risk of bleeding compared with ticagrelor [21][22][23][24]. In real-world clinical practice, the difference in baseline characteristics of the cohorts may potentially raise the risk of bleeding in the clopidogrel-treated patients compare with the ticagrelor-treated patients.…”

The Conundrum Surrounding Racial Differences on Ischaemic and Bleeding Risk with Dual Anti-Platelet Therapy

“…[26][27][28] East Asians also experience a greater exposure to prasugrel and ticagrelor compared with Caucasians, even after adjustment for body weight, thus suggesting that the optimal dose of the newer generation P2Y 12 inhibitors should be reduced. [29][30][31][32] Thrombogenicity is also quite variable among races, with substantial differences in coagulation, fibrinolysis, levels of haemostatic factors, plasma endothelial activation markers, genetic polymorphisms and inflammation processes. [33][34][35] Obesity is also associated with a pro-thrombotic status and appears to be less prevalent among East Asians.…”