Department of Internal Medicine, Gyeongsang National University, School of Medicine and Cardiovascular Center, Gyeongsang National University Changwon Hospital, Changwon, Korea.
Inova Center for Thrombosis Research and Drug Development, Inova Heart and Vascular Institute, Fairfax, Virginia, United States.
Curr Vasc Pharmacol. 2018;16(5):459-476. doi: 10.2174/1570161116666180117103238.
With over 1.5 billion people, East Asians are the most populous race in the world. Health status in this population is an important global issue. In the contemporary trials of antithrombotic treatment, East Asian patients have a lower risk for atherothrombotic diseases (especially, Coronary Artery Disease [CAD]) and a higher risk for bleeding (especially, gastrointestinal bleeding and hemorrhagic stroke). Despite these observations, antithrombotic treatment strategies in East Asian patients are mainly based on the American or European guidelines that are derived from randomized, controlled trials including mostly Caucasians. Despite a low response to clopidogrel, East Asian patients with CAD show a similar or even a lower rate of ischemic event occurrence and higher bleeding risk compared with Caucasian patients. The latter is referred to as the "East Asian Paradox", suggesting a dissimilar therapeutic window for antiplatelet therapy than Caucasians. In addition, different net clinical benefits have been observed between the races with potent P2Y12 inhibitors that may be related to racial differences in pharmacokinetic and pharmacodynamic profiles. Furthermore, there is emerging concern regarding differences between East Asian vs. Western patients in pharmacodynamic and clinical efficacies of anticoagulant agents. We now summarize experimental and clinical evidence of the efficacy and safety of antithrombotic agents in the East Asian population. We suggest the concept of "race-tailored antithrombotic treatment" in CAD patients and/or in patients undergoing percutaneous coronary intervention.
东亚人群拥有超过 15 亿人口，是世界上人口最多的种族。该人群的健康状况是一个重要的全球性问题。在当代抗栓治疗的临床试验中，东亚患者发生动脉粥样硬化血栓形成性疾病（尤其是冠心病）的风险较低，而出血（尤其是胃肠道出血和出血性卒中）的风险较高。尽管有这些观察结果，但东亚患者的抗栓治疗策略主要基于源自包括高加索人在内的随机对照试验的美国或欧洲指南。尽管东亚患者对氯吡格雷的反应较低，但与高加索患者相比，东亚 CAD 患者的缺血事件发生率相似甚至更低，出血风险更高。后者被称为“东亚悖论”，提示抗血小板治疗的治疗窗与高加索人不同。此外，不同种族之间观察到不同的净临床获益，与种族间药代动力学和药效学特征的差异有关。此外，人们越来越关注抗凝药物在东亚患者与西方患者之间的药效学和临床疗效的差异。我们现在总结了东亚人群中抗栓药物疗效和安全性的实验和临床证据。我们建议在 CAD 患者和/或经皮冠状动脉介入治疗的患者中采用“基于种族的抗栓治疗”的概念。
