{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,3]],"date-time":"2026-09-03T15:33:26Z","timestamp":1788449606001,"version":"build-2803163510"},"reference-count":30,"publisher":"Georg Thieme Verlag KG","issue":"10","funder":[{"name":"National Research Foundation (NRF) of Korea funded by the Ministry of Science, ICT, and Future Planning","award":["NRF-2015R1A5A2008833"],"award-info":[{"award-number":["NRF-2015R1A5A2008833"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Thromb Haemost"],"published-print":{"date-parts":[[2021,10]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:p>Compared with Caucasian patients, East Asian patients have the unique risk\u2013benefit trade-off and different responsiveness to antithrombotic regimens. The aim of this study was to compare pharmacodynamic profile in East Asian patients with acute coronary syndromes (ACSs) treated with prasugrel standard-dose versus a de-escalation strategy. Before discharge, ACS patients with age &lt;75 years or weight \u226560\u2009kg (n\u2009=\u2009255) were randomly assigned to the standard-dose (10-mg group) or de-escalation strategy (5-mg group or platelet function test [PFT]-guided group). After 1 month, VerifyNow P2Y12 assay-based platelet reactivity (P2Y12 reaction unit [PRU]) and bleeding episodes were evaluated. Primary endpoint was the percentage of patients with the therapeutic window (85 \u2264 PRU \u2264 208). The 250 patients completed 1-month treatment. The percentage of patients within the therapeutic window was significantly lower in the 10-mg group (n\u2009=\u200985) compared with the 5-mg (n\u2009=\u200983) and PFT-guided groups (n\u2009=\u200982) (35.3 vs. 67.5 vs. 65.9%) (odds ratio [OR]: 3.80 and 3.54; 95% confidence interval [CI]: 2.01\u20137.21 and 1.87\u20136.69, respectively). Compared with the 10-mg group, the bleeding rate was tended to be lower with de-escalation strategies (35.3 vs. 24.1% vs. 23.2%) (hazard ratio [HR]: 0.58 and 0.55; 95% CI: 0.30\u20131.14 and 0.28\u20131.09, respectively). \u201cPRU\u2009&lt;\u2009127\u201d was the optimal cut-off for predicting 1-month bleeding events (area under the curve: 0.616; 95% CI: 0.543\u20130.689; p\u2009=\u20090.005), which criteria was significantly associated with early discontinuation of prasugrel treatment (HR: 2.00; 95% CI: 1.28\u20133.03; p\u2009=\u20090.001). In conclusion, compared with the standard-dose prasugrel, the prasugrel de-escalation strategy in East Asian patients presented with ACS showed a higher chance within the therapeutic window and a lower tendency toward bleeding episodes.<\/jats:p><jats:p>\n          Registration\u2003URL: https:\/\/clinicaltrials.gov. Unique identifier:NCT01951001.<\/jats:p>","DOI":"10.1055\/a-1346-3300","type":"journal-article","created":{"date-parts":[[2021,1,5]],"date-time":"2021-01-05T23:43:11Z","timestamp":1609890191000},"page":"1376-1386","source":"Crossref","is-referenced-by-count":29,"title":["Pharmacodynamic Profile and Prevalence of Bleeding Episode in East Asian Patients with Acute Coronary Syndromes Treated with Prasugrel Standard-Dose versus De-escalation Strategy: A Randomized A-MATCH Trial"],"prefix":"10.1055","volume":"121","clinical-trial-number":[{"clinical-trial-number":"nct01951001","registry":"10.18810\/clinical-trials-gov"}],"author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-0403-3726","authenticated-orcid":false,"given":"Young-Hoon","family":"Jeong","sequence":"first","affiliation":[{"name":"Department of Internal Medicine, Gyeongsang National University School of Medicine and Cardiovascular Center, Gyeongsang National University Changwon Hospital, Changwon, South Korea"},{"name":"Institute of the Health Sciences, Gyeongsang National University, Jinju, South Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ju-Hyeon","family":"Oh","sequence":"first","affiliation":[{"name":"Division of Cardiology, Department of Internal Medicine, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon, South Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hyuck-Jun","family":"Yoon","sequence":"additional","affiliation":[{"name":"Division of Cardiology, Department of Internal Medicine, Keimyung University Dongsan Hospital, Daegu, South Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yongwhi","family":"Park","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Gyeongsang National University School of Medicine and Cardiovascular Center, Gyeongsang National University Changwon Hospital, Changwon, South Korea"},{"name":"Institute of the Health Sciences, Gyeongsang National University, Jinju, South Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jon","family":"Suh","sequence":"additional","affiliation":[{"name":"Division of Cardiology, Department of Internal Medicine, Soon Chun Hyang University Bucheon Hospital, Bucheon, South Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Se-Whan","family":"Lee","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Soonchunhyang University Cheonan Hospital, Cheonan, South Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kyounghoon","family":"Lee","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Gil Medical Center, Gachon University College of Medicine, Incheon, South Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jeong-Su","family":"Kim","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Pusan National University Yangsan Hospital, Yangsan, South Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Woo-Jung","family":"Chun","sequence":"additional","affiliation":[{"name":"Division of Cardiology, Department of Internal Medicine, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon, South Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yong-Hwan","family":"Park","sequence":"additional","affiliation":[{"name":"Division of Cardiology, Department of Internal Medicine, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon, South Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chang-Wook","family":"Nam","sequence":"additional","affiliation":[{"name":"Division of Cardiology, Department of Internal Medicine, Keimyung University Dongsan Hospital, Daegu, South Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"June-Hong","family":"Kim","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Pusan National University Yangsan Hospital, Yangsan, South Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jong-Hwa","family":"Ahn","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Gyeongsang National University School of Medicine and Gyeongsang National University Hospital, Jinju, South Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Seok-Jae","family":"Hwang","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Gyeongsang National University School of Medicine and Gyeongsang National University Hospital, Jinju, South Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jin-Yong","family":"Hwang","sequence":"additional","affiliation":[{"name":"Institute of the Health Sciences, Gyeongsang National University, Jinju, South Korea"},{"name":"Department of Internal Medicine, Gyeongsang National University School of Medicine and Gyeongsang National University Hospital, Jinju, South Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Udaya S.","family":"Tantry","sequence":"additional","affiliation":[{"name":"Sinai Center for Thrombosis Research and Drug Development, Sinai Hospital of Baltimore, Baltimore, Maryland, United States"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Paul A.","family":"Gurbel","sequence":"additional","affiliation":[{"name":"Sinai Center for Thrombosis Research and Drug Development, Sinai Hospital of Baltimore, Baltimore, Maryland, United States"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eun-Seok","family":"Shin","sequence":"additional","affiliation":[{"name":"Division of Cardiology, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, South Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"194","published-online":{"date-parts":[[2021,3,3]]},"reference":[{"issue":"14","key":"ref1","doi-asserted-by":"crossref","first-page":"1289","DOI":"10.1093\/eurheartj\/ehaa575","article-title":"ESC Guidelines for the management of acute coronary syndromes in patients presenting without persistent ST-segment elevation","volume":"42","author":"J P Collet","year":"2021","journal-title":"Eur Heart J"},{"issue":"03","key":"ref2","doi-asserted-by":"crossref","first-page":"213","DOI":"10.1093\/eurheartj\/ehx419","article-title":"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)","volume":"39","author":"M Valgimigli","year":"2018","journal-title":"Eur Heart J"},{"issue":"21","key":"ref3","doi-asserted-by":"crossref","first-page":"2028","DOI":"10.1016\/j.jacc.2008.04.002","article-title":"Early and late benefits of prasugrel in patients with acute coronary syndromes undergoing percutaneous coronary intervention: a TRITON-TIMI 38 (TRial to Assess Improvement in Therapeutic Outcomes by Optimizing Platelet InhibitioN with Prasugrel-Thrombolysis In Myocardial Infarction) analysis","volume":"51","author":"E M Antman","year":"2008","journal-title":"J Am Coll Cardiol"},{"issue":"03","key":"ref4","doi-asserted-by":"crossref","first-page":"240","DOI":"10.1161\/CIRCULATIONAHA.119.040167","article-title":"Defining high bleeding risk in patients undergoing percutaneous coronary intervention","volume":"140","author":"P Urban","year":"2019","journal-title":"Circulation"},{"issue":"20","key":"ref5","doi-asserted-by":"crossref","first-page":"1955","DOI":"10.1161\/CIRCULATIONAHA.117.031164","article-title":"International expert consensus on switching platelet P2Y12 receptor-inhibiting therapies","volume":"136","author":"D J Angiolillo","year":"2017","journal-title":"Circulation"},{"issue":"16","key":"ref6","doi-asserted-by":"crossref","first-page":"1521","DOI":"10.1016\/j.jcin.2019.03.034","article-title":"Updated expert consensus statement on platelet function and genetic testing for guiding P2Y12 receptor inhibitor treatment in percutaneous coronary intervention","volume":"12","author":"D Sibbing","year":"2019","journal-title":"JACC Cardiovasc Interv"},{"issue":"10","key":"ref7","doi-asserted-by":"crossref","first-page":"597","DOI":"10.1038\/nrcardio.2014.104","article-title":"Expert consensus document: World Heart Federation expert consensus statement on antiplatelet therapy in East Asian patients with ACS or undergoing PCI","volume":"11","author":"G N Levine","year":"2014","journal-title":"Nat Rev Cardiol"},{"key":"ref8","doi-asserted-by":"crossref","first-page":"166","DOI":"10.1016\/j.scib.2018.12.020","article-title":"2018 update of expert consensus statement on antiplatelet therapy in East Asian patients with ACS or undergoing PCI","volume":"64","author":"Y Huo","year":"2019","journal-title":"Sci Bull (Beijing)"},{"issue":"04","key":"ref9","doi-asserted-by":"crossref","first-page":"422","DOI":"10.1055\/s-0040-1718729","article-title":"The East Asian Paradox: an updated position statement on the challenges to the current antithrombotic strategy in patients with cardiovascular disease","volume":"121","author":"H K Kim","year":"2021","journal-title":"Thromb Haemost"},{"issue":"02","key":"ref10","doi-asserted-by":"crossref","first-page":"127","DOI":"10.1007\/s00228-009-0737-1","article-title":"The pharmacokinetics and pharmacodynamics of prasugrel in healthy Chinese, Japanese, and Korean subjects compared with healthy Caucasian subjects","volume":"66","author":"D S Small","year":"2010","journal-title":"Eur J Clin Pharmacol"},{"issue":"03","key":"ref11","doi-asserted-by":"crossref","first-page":"321","DOI":"10.1177\/0091270010367429","article-title":"Integrated analysis of pharmacokinetic data across multiple clinical pharmacology studies of prasugrel, a new thienopyridine antiplatelet agent","volume":"51","author":"D S Small","year":"2011","journal-title":"J Clin Pharmacol"},{"issue":"07","key":"ref12","doi-asserted-by":"crossref","first-page":"1684","DOI":"10.1253\/circj.CJ-13-1482","article-title":"Efficacy and safety of adjusted-dose prasugrel compared with clopidogrel in Japanese patients with acute coronary syndrome: the PRASFIT-ACS study","volume":"78","author":"S Saito","year":"2014","journal-title":"Circ J"},{"issue":"06","key":"ref13","doi-asserted-by":"crossref","first-page":"436","DOI":"10.7326\/M20-1806","article-title":"Age- and weight-adapted dose of prasugrel versus standard dose of ticagrelor in patients with acute coronary syndromes: results from a randomized trial","volume":"173","author":"M Menichelli","year":"2020","journal-title":"Ann Intern Med"},{"key":"ref14","doi-asserted-by":"crossref","first-page":"1079","DOI":"10.1016\/S0140-6736(20)31791-8","article-title":"Prasugrel-based de-escalation of dual antiplatelet therapy after percutaneous coronary intervention in patients with acute coronary syndrome (HOST-REDUCE-POLYTECH-ACS): an open-label, multicentre, non-inferiority randomised trial","volume":"396","author":"H S Kim","year":"2020","journal-title":"Lancet"},{"issue":"07","key":"ref15","doi-asserted-by":"crossref","first-page":"905","DOI":"10.1016\/j.amjcard.2011.05.020","article-title":"Efficacy and safety of intensive antiplatelet therapy with prasugrel from TRITON-TIMI 38 in a core clinical cohort defined by worldwide regulatory agencies","volume":"108","author":"S D Wiviott","year":"2011","journal-title":"Am J Cardiol"},{"issue":"23","key":"ref16","doi-asserted-by":"crossref","first-page":"2736","DOI":"10.1161\/CIRCULATIONAHA.110.009449","article-title":"Standardized bleeding definitions for cardiovascular clinical trials: a consensus report from the Bleeding Academic Research Consortium","volume":"123","author":"R Mehran","year":"2011","journal-title":"Circulation"},{"issue":"02","key":"ref17","doi-asserted-by":"crossref","first-page":"227","DOI":"10.1093\/eurheartj\/ehp434","article-title":"Correlation of inhibition of platelet aggregation after clopidogrel with post discharge bleeding events: assessment by different bleeding classifications","volume":"31","author":"V Serebruany","year":"2010","journal-title":"Eur Heart J"},{"issue":"01","key":"ref18","doi-asserted-by":"crossref","first-page":"1229","DOI":"10.1038\/s41598-017-18134-y","article-title":"Effects of genetic variants on platelet reactivity and one-year clinical outcomes after percutaneous coronary intervention: a prospective multicentre registry study","volume":"8","author":"H J Joo","year":"2018","journal-title":"Sci Rep"},{"issue":"05","key":"ref19","first-page":"620","article-title":"A pharmacodynamic study of the optimal P2Y12 inhibitor regimen for East Asian patients with acute coronary syndrome","volume":"30","author":"J H Lee","year":"2015","journal-title":"Korean J Intern Med (Korean Assoc Intern Med)"},{"key":"ref20","doi-asserted-by":"crossref","first-page":"1747","DOI":"10.1016\/S0140-6736(17)32155-4","article-title":"Guided de-escalation of antiplatelet treatment in patients with acute coronary syndrome undergoing percutaneous coronary intervention (TROPICAL-ACS): a randomised, open-label, multicentre trial","volume":"390","author":"D Sibbing","year":"2017","journal-title":"Lancet"},{"issue":"24","key":"ref21","doi-asserted-by":"crossref","first-page":"1942","DOI":"10.1093\/eurheartj\/ehz202","article-title":"Platelet reactivity and clinical outcomes in acute coronary syndrome patients treated with prasugrel and clopidogrel: a pre-specified exploratory analysis from the TROPICAL-ACS trial","volume":"40","author":"D Aradi","year":"2019","journal-title":"Eur Heart J"},{"issue":"01","key":"ref22","doi-asserted-by":"crossref","first-page":"149","DOI":"10.1055\/s-0038-1676545","article-title":"Racial differences in ischaemia\/bleeding risk trade-off during antiplatelet therapy: individual patient level landmark meta-analysis from seven RCTs","volume":"119","author":"J Kang","year":"2019","journal-title":"Thromb Haemost"},{"issue":"24","key":"ref23","doi-asserted-by":"crossref","first-page":"2428","DOI":"10.1001\/jama.2019.8146","article-title":"Effect of P2Y12 inhibitor monotherapy vs dual antiplatelet therapy on cardiovascular events in patients undergoing percutaneous coronary intervention: The SMART-CHOICE randomized clinical trial","volume":"321","author":"J Y Hahn","year":"2019","journal-title":"JAMA"},{"issue":"23","key":"ref24","doi-asserted-by":"crossref","first-page":"2407","DOI":"10.1001\/jama.2020.7580","article-title":"Effect of ticagrelor monotherapy vs ticagrelor with aspirin on major bleeding and cardiovascular events in patients with acute coronary syndrome: the TICO randomized clinical trial","volume":"323","author":"B K Kim","year":"2020","journal-title":"JAMA"},{"issue":"14","key":"ref25","doi-asserted-by":"crossref","first-page":"1170","DOI":"10.4244\/EIJ-D-20-00187","article-title":"A Prospective, multicenter, randomized, open-label trial to compare efficacy and safety of clopidogrel vs. ticagrelor in stabilized patients with acute myocardial infarction after percutaneous coronary intervention: rationale and design of the TALOS-AMI trial","volume":"16","author":"M W Park","year":"2021","journal-title":"EuroIntervention"},{"key":"ref26","doi-asserted-by":"crossref","first-page":"128","DOI":"10.1016\/j.ijcard.2016.01.102","article-title":"The challenge for predicting bleeding events by assessing platelet reactivity following coronary stenting","volume":"207","author":"S Y Choi","year":"2016","journal-title":"Int J Cardiol"},{"issue":"05","key":"ref27","doi-asserted-by":"crossref","first-page":"979","DOI":"10.1160\/TH15-05-0366","article-title":"Influence of platelet reactivity on BARC classification in East Asian patients undergoing percutaneous coronary intervention. Results of the ACCEL-BLEED study","volume":"115","author":"T J Kwon","year":"2016","journal-title":"Thromb Haemost"},{"issue":"21","key":"ref28","doi-asserted-by":"crossref","first-page":"2130","DOI":"10.1016\/j.jacc.2013.02.044","article-title":"Nuisance bleeding with prolonged dual antiplatelet therapy after acute myocardial infarction and its impact on health status","volume":"61","author":"A P Amin","year":"2013","journal-title":"J Am Coll Cardiol"},{"issue":"06","key":"ref29","doi-asserted-by":"crossref","first-page":"789","DOI":"10.1177\/0091270011406280","article-title":"Relationship between exposure to prasugrel active metabolite and clinical outcomes in the TRITON-TIMI 38 substudy","volume":"52","author":"J S Riesmeyer","year":"2012","journal-title":"J Clin Pharmacol"},{"issue":"14","key":"ref30","doi-asserted-by":"crossref","first-page":"e012078","DOI":"10.1161\/JAHA.119.012078","article-title":"Safety and Effectiveness of contemporary P2Y12 inhibitors in an East Asian population with acute coronary syndrome: A nationwide population-based cohort study","volume":"8","author":"J E Yun","year":"2019","journal-title":"J Am Heart Assoc"}],"container-title":["Thrombosis and Haemostasis"],"original-title":[],"language":"en","link":[{"URL":"http:\/\/www.thieme-connect.de\/products\/ejournals\/pdf\/10.1055\/a-1346-3300.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2022,8,10]],"date-time":"2022-08-10T14:21:56Z","timestamp":1660141316000},"score":1,"resource":{"primary":{"URL":"http:\/\/www.thieme-connect.de\/DOI\/DOI?10.1055\/a-1346-3300"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,1,5]]},"references-count":30,"journal-issue":{"issue":"10","published-online":{"date-parts":[[2021,10,6]]},"published-print":{"date-parts":[[2021,10]]}},"URL":"https:\/\/doi.org\/10.1055\/a-1346-3300","archive":["Portico","CLOCKSS"],"relation":{},"ISSN":["0340-6245","2567-689X"],"issn-type":[{"value":"0340-6245","type":"print"},{"value":"2567-689X","type":"electronic"}],"subject":[],"published-other":{"date-parts":[[2021,1,5]]},"published":{"date-parts":[[2021,1,5]]}}}