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Nat Rev Cardiol. 2014 Oct;11(10):597-606. doi: 10.1038/nrcardio.2014.104. Epub 2014 Aug 26.

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

Author information

1
Baylor College of Medicine and Michael E. DeBakey VA Medical Center, 2002 Holcombe Boulevard, Houston, TX 77030, USA.
2
Gyeongsang National University Hospital and Gyeongsang National University School of Medicine, 79, Gangnam-ro, Jinju-si, Gyeongsangnam-do, 660-702, South Korea.
3
Department of Medicine (Cardiology), Tokai University School of Medicine, 143 Shimokasuya, Isehara, Kanagawa 259-1143, Japan.
4
Intermountain Medical Center, University of Utah School of Medicine, 5121 South Cottonwood Street, Murray, UT 84157, USA.
5
Department of Cardiology, Peking University First Hospital, Xueyuan Road, Haidian District, Beijing, 100083, China.
6
Brigham and Women's Hospital, TIMI Study Group, 350 Longwood Avenue, Boston, MA 02115, USA.
7
World Heart Federation, 32, rue de Malatrex, 1201 Geneva, Switzerland.
8
Division of Cardiology, University of North Carolina, 160 Dental Circle, CB 7075, Chapel Hill, NC 27599, USA.

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.

PMID:
25154978
DOI:
10.1038/nrcardio.2014.104
[Indexed for MEDLINE]

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