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Thromb Haemost 2021; 121(04): 422-432
DOI: 10.1055/s-0040-1718729
Review Article

The East Asian Paradox: An Updated Position Statement on the Challenges to the Current Antithrombotic Strategy in Patients with Cardiovascular Disease

Hyun Kuk Kim
1   Department of Cardiology, Chosun University Hospital, Gwangju, South Korea
,
Udaya S. Tantry
2   Sinai Center for Thrombosis Research, Sinai Hospital of Baltimore, Baltimore, Maryland, United States
,
Sidney C. Smith Jr.
3   Division of Cardiology, University of North Carolina, Chapel Hill, North Carolina, United States
,
Myung Ho Jeong
4   Department of Cardiology, Chonnam National University Hospital, Gwangju, South Korea
,
Seung-Jung Park
5   The Heart Institute, Asan Medical Center, University of Ulsan, Seoul, South Korea
,
Moo Hyun Kim 
6   Department of Cardiology, Dong-A University Hospital, Busan, South Korea
,
Do-Sun Lim
7   Department of Cardiology, Cardiovascular Center, Korea University Anam Hospital, Seoul, South Korea
,
Eun-Seok Shin
8   Division of Cardiology, Ulsan Hospital, Ulsan, South Korea
,
Duk-Woo Park
5   The Heart Institute, Asan Medical Center, University of Ulsan, Seoul, South Korea
,
Yong Huo
9   Department of Cardiology, Peking University First Hospital, Beijing, China
,
Shao-Liang Chen
10   Cardiovascular Department, Nanjing First Hospital, Nanjing Medical University, Nanjing, China
,
Zheng Bo
9   Department of Cardiology, Peking University First Hospital, Beijing, China
,
Shinya Goto 
11   Department of Medicine (Cardiology), Tokai University School of Medicine, Kanagawa, Japan
,
Takeshi Kimura
12   Department of Cardiovascular Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan
,
Satoshi Yasuda
13   National Cerebral and Cardiovascular Center, Suita, Osaka, Japan
,
Wen-Jone Chen
14   Department of Internal Medicine, Cardiology Division, National Taiwan University Hospital, Taipei, Taiwan
,
Mark Chan
15   Department of Cardiology, National University Heart Centre Singapore, Singapore, Singapore
,
Daniel Aradi
16   Heart Centre Balatonfüred and Heart and Vascular Centre, Semmelweis University, Budapest, Hungary
,
Tobias Geisler
17   Department of Cardiology and Cardiovascular Medicine, University Hospital of Tübingen, Tübingen, Germany
,
Diana A. Gorog
18   National Heart and Lung Institute, Imperial College, London, United Kingdom
19   Postgraduate Medical School, University of Hertfordshire, Hertfordshire, United Kingdom
,
Dirk Sibbing
20   Department of Cardiology, LMU München, Munich, Germany
21   DZHK (German Centre for Cardiovascular Research), partner site Munich Heart Alliance, Munich, Germany
,
Gregory Y. H. Lip 
22   Liverpool Centre for Cardiovascular Science, University of Liverpool and Liverpool Heart & Chest Hospital, Liverpool, United Kingdom
,
Dominick J. Angiolillo
23   Division of Cardiology, University of Florida College of Medicine, Jacksonville, Florida, United States
,
Paul A. Gurbel
2   Sinai Center for Thrombosis Research, Sinai Hospital of Baltimore, Baltimore, Maryland, United States
,
Young-Hoon Jeong
24   Department of Internal Medicine, Gyeongsang National University School of Medicine and Cardiovascular Center, Gyeongsang National University Changwon Hospital, Changwon, South Korea
25   Institute of the Health Sciences, Gyeongsang National University, Jinju, South Korea
› Author Affiliations Funding This study was supported by Basic Science Research Program through the National Research Foundation (NRF) of Korea funded by the Ministry of Science, ICT, and Future Planning (NRF-2015R1A5A2008833). The authors are solely responsible for the design and conduct of this review, the drafting, and editing of the manuscript, and its final contents.
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Abstract

East Asian patients have reduced anti-ischemic benefits and increased bleeding risk during antithrombotic therapies compared with Caucasian patients. As potent P2Y12 receptor inhibitors (e.g., ticagrelor and prasugrel) and direct oral anticoagulants are commonly used in current daily practice, the unique risk–benefit trade-off in East Asians has been a topic of emerging interest. In this article, we propose updated evidence and future directions of antithrombotic treatment in East Asian patients.

Keywords

race - antiplatelet therapy - direct oral anticoagulants - ischemic risk - bleeding risk


Publication History

Received: 07 July 2020

Accepted: 09 September 2020

Article published online:
10 November 2020

© 2020. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 

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