Antithrombotic strategy for patients with acute coronary syndrome: A perspective from east asia

Yohei Numasawa, Mitsuaki Sawano, Ryoma Fukuoka, Kentaro Ejiri, Toshiki Kuno, Satoshi Shoji, Shun Kohsaka

Research output: Contribution to journalReview articlepeer-review

19 Citations (Scopus)


Dual antiplatelet therapy (DAPT) after percutaneous coronary intervention has become the standard of care, particularly in patients with acute coronary syndrome (ACS). Current clinical guidelines recommend novel P2Y12 inhibitors (e.g., prasugrel or ticagrelor) in addition to aspirin based on the results of representative randomized controlled trials conducted predominantly in Western countries. These agents were superior to clopidogrel in reducing the composite ischemic events, with a trade-off of the increased bleeding events. However, multiple differences exist between East Asian and Western patients, especially with respect to their physique, thrombogenicity, hemorrhagic diathesis, and on-treatment platelet reactivity. Recent studies from East Asian countries (e.g., Japan or South Korea) have consistently demonstrated that use of novel P2Y12 inhibitors is associated with a higher risk of bleeding events than use of clopidogrel, despite borderline statistical difference in the incidence of composite ischemic events. Additionally, multiple studies have shown that the optimal duration of DAPT may be shorter in East Asian than Western patients. This review summarizes clinical studies of antithrombotic strategies in East Asian patients with ACS. Understanding these differences in antithrombotic strategies including DAPT and their impacts on clinical outcomes will aid in selection of the optimal tailored antithrombotic therapy for patients with ACS.

Original languageEnglish
Article number1963
Pages (from-to)1-19
Number of pages19
JournalJournal of Clinical Medicine
Issue number6
Publication statusPublished - Jun 2020
Externally publishedYes


  • Acute coronary syndrome
  • Dual antiplatelet therapy
  • P2Y12 inhibition
  • Percutaneous coronary intervention
  • Tailored therapy

ASJC Scopus subject areas

  • General Medicine


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