“East Asian Paradox”: Challenge for the Current Antiplatelet Strategy of “One-Guideline-Fits-All Races” in Acute Coronary Syndrome

Global Cardiovascular Health (SC Smith, Section Editor)
Part of the following topical collections:
  1. Topical Collection on Global Cardiovascular Health


Clinical experiences have suggested that East Asians show the higher risk of warfarin-related intracranial hemorrhage compared with Westerners. Therefore, different target of the International Normalized Ratio (INR) in East Asians (1.6–2.6) has been proposed and adapted in clinical practice. In terms with antiplatelet therapy, recent evidence has supported the concept of “therapeutic level of platelet reactivity” to balance clinical efficacy and safety in patients undergoing percutaneous coronary intervention (PCI) or those with acute coronary syndrome (ACS). In line with the warfarin experiences, multiple clinical and pharmacodynamic data from East Asians have shown their different therapeutic level of platelet reactivity following PCI or ACS (“East Asian Paradox”). Furthermore, like most cardiovascular drugs, P2Y12 receptor blockers have marked interethnic differences in the pharmacokinetics and pharmacodynamics. The currently performed clinical trials evaluating the clinical efficacy and safety of potent P2Y12 inhibitors mostly don’t include enough number of East Asians to draw reliable conclusions. Therefore, dedicated research and guideline(s) for East Asians are required before we can apply Western recommendations for potent P2Y12 inhibitors in East Asian population. It is a time to consider the paradigm shift from “one-guideline-fits-all races” to “race-tailored antiplatelet therapy” in treating ACS patients.


Race Warfarin P2Y12 inhibitor Acute coronary syndrome Thrombogenicity East Asian Paradox Antiplatelet strategy 



This study was partly supported by grants from Institute of the Health Sciences, Gyeongsang National University.

Compliance with Ethics Guidelines

Conflict of Interest

Young-Hoon Jeong has received honoraria for lectures from Sanofi-Aventis, Daiichi Sankyo/Lilly, AstraZeneca, Haemonetics, and Otsuka; and research grants or support from Han-mi Pharmaceuticals, Boehringer-Ingelheim, Otsuka, Accumetrics, and Haemonetics.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.


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© Springer Science+Business Media New York 2014

Authors and Affiliations

  1. 1.Division of Cardiology, Department of Internal MedicineGyeongsang National University Hospital and Gyeongsang National University School of MedicineJinjuKorea

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