Position Statement on Antiplatelet Therapy for East Asians With Coronary Artery Disease: 2025 Update

Growing clinical evidence has indicated that East Asian patients have a lower risk for cardiovascular events but a higher risk of serious bleeding during antiplatelet therapy compared with Western populations—referred to as the “East Asian Paradox.” The unique risk-benefit tradeoff observed in East Asian populations has been a topic of interest, which may be influenced by a complex interplay of genetic and environmental risk factors—such as specific atherothrombotic cardiovascular risks, helicobacter pylori infection, sites of cranial atherosclerosis, and low body weight. There exist knowledge gaps in the antiplatelet therapy among East Asian populations with coronary artery disease, such as the individualized assessment of ischemic and bleeding risk, de-escalation strategy of dual antiplatelet therapy and the compliance of long-term secondary prevention. A substantial body of positive evidence supporting de-escalation strategies of dual antiplatelet therapy comes from East Asia, possibly caused by the distinct therapeutic range of antiplatelet effects and heightened pharmacodynamic response to potent P2Y₁₂ inhibitors observed in this population. This consensus update focuses on the latest progress and hotspot issues on antiplatelet therapy in the East Asian population with coronary artery disease and therapeutic recommendations based on the best available evidence.