• 1 National Heart Centre Singapore
  • 2 College of Medicine and Public Health, Flinders University Adelaide, Australia
  • 3 Hospital Pulau Pinang Penang, Malaysia
  • 4 Kitasato University and Hospital Tokyo, Japan
  • 5 All India Institute of Medical Sciences New Delhi, India
  • 6 National University Hospital Singapore
  • 7 Seoul National University Hospital Internal Medicine Seoul, South Korea
  • 8 Medanta - The Medicity Gurgaon, India
  • 9 Chang Gung Memorial Hospital Taoyuan City, Taiwan
  • 10 Heart Institute of Ho Chi Minh City Ho Chi Minh, Vietnam
  • 11 Ripas Hospital Brunei
  • 12 Universitas Indonesia Jakarta, Indonesia
  • 13 Yonsei University College of Medicine Seoul, South Korea
  • 14 Asan Medical Center, University of Ulsan Seoul, South Korea
  • 15 Queen Elizabeth Hospital Hong Kong, China
  • 16 National Cheng King University Hospital Tainan, Taiwan
  • 17 Cleveland Clinic Abu Dhabi United Arab Emirates
  • 18 University of the Philippines-Philippine General Hospital Manila, Philippines
  • 19 Khoo Teck Puat Hospital Singapore
  • 20 China Medical University Hospital Taichung City, Taiwan
  • 21 Taipei Medical University Taipei, Taiwan
  • 22 Sorbonne University Paris, France
Eur Cardiol, 2021 Feb;16:e02.
PMID: 33708263 DOI: 10.15420/ecr.2020.40


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.

* Title and MeSH Headings from MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine.