Antithrombotic Therapy After Acute Coronary Syndromes or Percutaneous Coronary Interventions in East Asian Populations

Because guidelines and recommendations in response to multiple randomized clinical trials (RCTs) of new therapies undergo rapid changes, antithrombotic therapies for patients after acute coronary syndrome, or percutaneous coronary intervention, are becoming more complex in daily clinical practice. The proportion of Asian populations enrolled in landmark RCTs is substantially low, which limits the direct application of trial findings into clinical practice in Asian countries. Moreover, compared with Caucasian patients, East Asian patients are considered to have a different ischemia/bleeding propensity in response to antithrombotic therapy, known as the “East Asian paradox” (ie, more bleeding events but fewer thromboembolic events). Coincident with consecutive RCTs in Western populations to optimize antithrombotic strategies, several such studies have now been conducted in East Asian cohorts. Herein, we provide a comprehensive summary of the key RCTs in this regard and propose future directions and perspectives for optimal antithrombotic therapies in East Asian patients. [Display omitted] •Optimal antithrombotic strategies are a cornerstone of the management of ACS or PCI and have constantly evolved to balance ischemia and bleeding.•East Asian patients have reduced anti-ischemic benefits and an increased bleeding risk during antithrombotic therapies compared with Caucasian patients.•A one-size-fits-all approach is not suited to antithrombotic therapies for East Asians following ACS or PCI; a careful assessment of thrombotic risk vs bleeding risk is thus required via a tailored, potentially dynamic strategy, as well as a treatment plan based on individual risk.•Active clinical trials evaluating diverse strategies or investigational agents may improve the risk-benefit balance in current antithrombotic strategies.