World Heart Federation Expert Consensus Statement on Antiplatelet Therapy in East Asian Patients with ACS or Undergoing PCI

Abstract

Guideline recommendations on the use of dual antiplatelet therapy (DAPT) in patients with acute coronary syndromes and in those undergoing percutaneous coronary intervention (PCI) have been formulated by both the ACC/AHA and the ESC. These recommendations are based primarily on large, phase III, randomized, controlled trials of the P2Y12 inhibitors clopidogrel, prasugrel, and ticagrelor. However, few East Asian patients have been included in the trials to assess the use of these agents, particularly the newer agents prasugrel and ticagrelor. Additionally, an increasing body of data suggests that East Asian patients have differing risk profiles for both thrombophilia and bleeding compared with white patients, and that a different 'therapeutic window' of on-treatment platelet reactivity might be appropriate in East Asian patients. Furthermore, a phenomenon referred to as the 'East Asian paradox' has been described, in which East Asian patients have a similar or even a lower rate of ischaemic events after PCI compared with white patients, despite a higher level of platelet reactivity during DAPT. Recognizing these concerns, the World Heart Federation has undertaken this evidence-based review and produced this expert consensus statement to determine the antiplatelet treatment strategies that are most appropriate for East Asian patients.

Prognostic value of the GRACE discharge score for predicting the mortality of patients with stable coronary artery disease who underwent percutaneous coronary intervention

“…Fourth, a previous study showed the "East Asia paradox": East Asian patients had fewer ischemic events after PCI compared with Western patients. 16 Kumar et al 17 reported that the rate of composite adverse event endpoints after stent implantation for the Asian population, including death or MI, was lower than that for Caucasians, even after adjusting for risk factors. However, the GRACE discharge score still showed long-term out-of-hospital prognostic value for the mortality of patients with SCAD after PCI.…”

Streamlining the learning process for TAVI: Insight from a comparative analysis of the OCEAN‐TAVI and the massy registries

“…From the perspective of studies in the US, the reported bleeding rate was higher in Asian‐Americans compared to Caucasian‐Americans treated with percutaneous coronary intervention for acute coronary syndrome . A previous report has suggested that East Asians have different risk profiles for bleeding compared with Caucasians, and that a different “therapeutic window” of on‐treatment platelet reactivity might be appropriate in East Asians . Optimal antiplatelet or anticoagulant therapies during TAVI for Asian populations should be thoroughly investigated.…”

Comparison of Hemorrhagic Risk between Prasugrel and Clopidogrel: a Retrospective Study using Adverse Drug Event Reporting Databases

“…Furthermore, a prospective observational study reported that the ischemic and bleeding event rates were similar between Japanese ACS patients at high bleeding risk receiving a low-maintenance dose of prasugrel and those at non-high bleeding risk receiving a standard maintenance dose of prasugrel [12]. However, given the known marked interethnic differences in the pharmacokinetic and pharmacodynamic profiles between prasugrel and clopidogrel [1,2], the findings of these studies [11,12] may not be applicable to other ethnic groups. Further studies are necessary to examine the efficacy and safety of a step-down regimen or a low-dose prasugrel regimen in various ethnic populations.…”

“…Clopidogrel and prasugrel are P2Y12 inhibitors, thienopyridine antiplatelet agents. Prasugrel is a new-generation agent that inhibits platelet aggregation more potently and exerts therapeutic action faster Ivyspring International Publisher than clopidogrel [1,2]. Clopidogrel and prasugrel show markedly different pharmacokinetic and pharmacodynamic profiles.…”