Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Review
. 2021 Mar 2:16:e02.
doi: 10.15420/ecr.2020.40. eCollection 2021 Feb.

2020 Asian Pacific Society of Cardiology Consensus Recommendations on the Use of P2Y12 Receptor Antagonists in the Asia-Pacific Region

Jack Wc Tan  1   2 , Derek P Chew  3 , Muhamad Ali Sk Abdul Kader  4 , Junya Ako  5 , Vinay K Bahl  6 , Mark Chan  7 , Kyung Woo Park  8 , Praveen Chandra  9 , I-Chang Hsieh  10 , Do Quang Huan  11 , Sofian Johar  12 , Dafsah Arifa Juzar  13 , Byeong-Keuk Kim  14 , Cheol Whan Lee  15 , Michael Kang-Yin Lee  16 , Yi-Heng Li  17 , Wael Almahmeed  18 , Eric Oliver Sison  19 , Doreen Tan  20 , Yu-Chen Wang  21 , Shiuan Jong Yeh  22 , Gilles Montalescot  23   24   25
Affiliations
Review

2020 Asian Pacific Society of Cardiology Consensus Recommendations on the Use of P2Y12 Receptor Antagonists in the Asia-Pacific Region

Jack Wc Tan et al. Eur Cardiol. .

Abstract

The unique characteristics of patients with acute coronary syndrome in the Asia-Pacific region mean that international guidelines on the use of dual antiplatelet therapy (DAPT) cannot be routinely applied to these populations. Newer generation P2Y12 inhibitors (i.e. ticagrelor and prasugrel) have demonstrated improved clinical outcomes compared with clopidogrel. However, low numbers of Asian patients participated in pivotal studies and few regional studies comparing DAPTs have been conducted. This article aims to summarise current evidence on the use of newer generation P2Y12 inhibitors in Asian patients with acute coronary syndrome and provide recommendations to assist clinicians, especially cardiologists, in selecting a DAPT regimen. Guidance is provided on the management of ischaemic and bleeding risks, including duration of therapy, switching strategies and the management of patients with ST-elevation and non-ST-elevation MI or those requiring surgery. In particular, the need for an individualised DAPT regimen and considerations relating to switching, de-escalating, stopping or continuing DAPT beyond 12 months are discussed.

Keywords: Asia-Pacific; P2Y12 inhibitors; acute coronary syndrome; aspirin; bleeding; consensus.

PubMed Disclaimer

Conflict of interest statement

Disclosure: This work was funded through the Asian Pacific Society of Cardiology by unrestricted educational grants from Abbott Vascular, Amgen, AstraZeneca, Bayer and Roche Diagnostics. JWCT has received honoraria from AstraZeneca, Bayer, Amgen, Medtronic, Abbott Vascular, Biosensors, Orbus Neich, Boehringer Ingelheim and Pfizer; and research grants from Medtronic, Abbott Diagnostics and Beckmann. DPC reports consulting fee from Asian Pacific Society of Cardiology; support for travel to meetings for the study or otherwise from Asian Pacific Society of Cardiology; grants/grants pending from Roche Diagnostics; and payment for development of educational presentations including service on speakers' bureaus from AstraZeneca. JA reports honoraria from AstraZeneca, Daiichi Sankyo, Bayer and Sanofi; and grants/grants pending from Daiichi Sankyo. MC reports consulting fee/honorarium from AstraZeneca. KWP reports consulting fee from Arnold & Porter LLP. DQH reports consulting fee or honorarium from AstraZeneca; and support for travel to meetings for the study or otherwise from AstraZeneca. SJ reports honorarium from Medtronic; and travel/accommodation expenses from Medtronic and Edward Lifesciences. DAJ reports board membership at Menarini; honorarium from AstraZeneca; and travel/accommodation expenses from Boston Scientific. DT reports honorarium from The Meeting Lab; and travel/accommodation expenses paid to institution from The Meeting Lab. GM reports research grants to the institution or consulting/lecture fees from Abbott, Amgen, Actelion, American College of Cardiology Foundation, AstraZeneca, Axis-Santé, Bayer, Boston-Scientific, Boehringer Ingelheim, Bristol-Myers Squibb, Beth Israel Deaconess Medical, Brigham Women's Hospital, Idorsia, Elsevier, Fédération Française de Cardiologie, Frequence Medicale, ICAN, Lead-Up, Medtronic, Menarini, MSD, Pfizer, Quantum Genomics, Sanofi, SCOR global life, Servier and WebMD. All other authors have no conflicts of interest to declare.

Figures

Figure 1:
Figure 1:. Treatment Algorithm for Patients with STEMI
Figure 2:
Figure 2:. Treatment Algorithm for Patients with NSTEMI
See this image and copyright information in PMC

Similar articles

See all similar articles

Cited by

See all "Cited by" articles

References

    1. Chan MY, Du X, Eccleston D et al. Acute coronary syndrome in the Asia-Pacific region. Int J Cardiol. 2016;202:861–9. doi: 10.1016/j.ijcard.2015.04.073. - DOI - PubMed
    1. Levine GN, Bates ER, Bittl JA et al. 2016 ACC/AHA guideline focused update on duration of dual antiplatelet therapy in patients with coronary artery disease. Circulation. 2016;134:e123–55. doi: 10.1161/cir.0000000000000404. - DOI - PubMed
    1. Valgimigli M, Bueno H, Byrne RA et al. 2017 ESC focused update on dual antiplatelet therapy in coronary artery disease developed in collaboration with EACTS: the Task Force for dual antiplatelet therapy in coronary artery disease of the European Society of Cardiology (ESC) and of the European Association for Cardio-Thoracic Surgery (EACTS). Eur Heart J. 2018;39:213–213. doi: 10.1093/eurheartj/ehx419. - DOI - PubMed
    1. Jeong YH. “East Asian Paradox”: challenge for the current antiplatelet strategy of “one-guideline-fits-all races” in acute coronary syndrome. Curr Cardiol Rep. 2014;16:485. doi: 10.1007/s11886-014-0485-4. - DOI - PubMed
    1. Scott SA, Sangkuhl K, Gardner EE et al. Clinical Pharmacogenetics Implementation Consortium guidelines for cytochrome P450-2C19 (CYP2C19) genotype and clopidogrel therapy. Clin Pharmacol Ther. 2011;90:328–32. doi: 10.1038/clpt.2011.132. - DOI - PMC - PubMed

LinkOut - more resources