A specific set of guidelines are needed for the treatment of East Asian patients who require antiplatelet drugs, according to an expert consensus statement published online in Nature Reviews Cardiology. East Asian patients have an increased risk of bleeding when taking antiplatelet drugs, which are used after heart attacks and coronary stenting (to reopen a blocked artery) to prevent clotting and reduce the risk of a subsequent heart attack. Recognizing this risk, the World Heart Federation has undertaken an evidence-based review to determine the antiplatelet strategies that might be most appropriate for East Asian patients. Effective prevention and treatment strategies in patients with cardiovascular disease will be important contributors to achieving the World Health Organization's goal of reducing the global rate of premature death from noncommunicable diseases by 25% by 2025.
Clinical guidelines from both Europe and the USA recommend dual antiplatelet therapy, using aspirin and another drug from a newer class of antiplatelet medications, in patients with acute coronary syndrome and in those undergoing interventions that widen the coronary artery with stent placement. However, the clinical trials of the newer antiplatelet drugs on which these recommendations are based have included few patients of East Asian ethnicity. Given that East Asian patients have a different bleeding and clotting profile from white patients, extrapolation of existing guidelines to East Asian patients, although common, might not be appropriate. In this expert consensus document, Sidney Smith Jr and colleagues review the available data and clinical experience from East Asian countries, and draw conclusions that should be taken into consideration to optimize antiplatelet therapy for East Asian patients.