{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,15]],"date-time":"2026-09-15T07:28:49Z","timestamp":1789457329228,"version":"build-2803163510"},"reference-count":23,"publisher":"Oxford University Press (OUP)","issue":"2","license":[{"start":{"date-parts":[[2023,11,13]],"date-time":"2023-11-13T00:00:00Z","timestamp":1699833600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/journals\/pages\/open_access\/funder_policies\/chorus\/standard_publication_model"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2024,2,23]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:sec>\n                  <jats:title>Aims<\/jats:title>\n                  <jats:p>Randomized controlled trials (RCTs) testing bleeding reduction strategies using antiplatelet treatment regimens (BRATs) in acute coronary syndromes (ACS) have shown promising results, but the generalizability of these findings may be significantly influenced by the ethnicity of the patients enrolled, given that East Asian (EA) patients show different ischaemic-bleeding risk profile compared to non-EA patients.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods and results<\/jats:title>\n                  <jats:p>RCTs comparing a BRAT vs. standard 12-month dual antiplatelet therapy (DAPT) in patients with ACS undergoing percutaneous coronary intervention (PCI) were selected. The primary efficacy endpoint was major adverse cardiovascular events (MACE) as defined in each trial and the primary safety endpoint was minor or major bleeding. Twenty-six RCTs testing seven different BRATs were included. The only strategy associated with a trade-off in MACE was \u2018upfront unguided de-escalation\u2019 in the subgroup of non-EAs (risk ratio 1.16, 95% confidence interval 1.09\u20131.24). All but aspirin monotherapy-based strategies (i.e. \u2018short and very short DAPT followed by aspirin\u2019) were associated with reduced bleeding compared with standard DAPT in both EA and non-EA patients. There were no significant differences between subgroups, but the lack of RCTs in some of the included strategies and the difference in the certainty of evidence between EA and non-EA patients revealed that the evidence in support of different BRATs in ACS undergoing PCI is influenced by ethnicity. Moreover, absolute risk reduction estimation revealed that some BRATs might be more effective than others in reducing bleeding according to ethnicity.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusion<\/jats:title>\n                  <jats:p>The majority of BRATs are associated with reduced bleeding without any trade-off in hard ischaemic endpoints regardless of ethnicity. However, the supporting evidence and relative safety profiles of different BRATs might be significantly affected by ethnicity, which should be taken into account in clinical practice.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Study registration<\/jats:title>\n                  <jats:p>This study is registered in PROSPERO (CRD42023416710).<\/jats:p>\n               <\/jats:sec>","DOI":"10.1093\/ehjcvp\/pvad085","type":"journal-article","created":{"date-parts":[[2023,11,14]],"date-time":"2023-11-14T07:53:00Z","timestamp":1699948380000},"page":"158-169","source":"Crossref","is-referenced-by-count":35,"title":["Impact of ethnicity on antiplatelet treatment regimens for bleeding reduction in acute coronary syndromes: a systematic review and pre-specified subgroup meta-analysis"],"prefix":"10.1093","volume":"10","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-3909-182X","authenticated-orcid":false,"given":"Mattia","family":"Galli","sequence":"first","affiliation":[{"name":"Maria Cecilia Hospital, GVM Care & Research , Cotignola , Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Renzo","family":"Laborante","sequence":"additional","affiliation":[{"name":"Catholic University of the Sacred Heart , Rome , Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Giovanni","family":"Occhipinti","sequence":"additional","affiliation":[{"name":"Division of Cardiology, Azienda Ospedaliero Universitaria Policlinico \u2018G. Rodolico-San Marco', University of Catania , Catania , Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andea","family":"Zito","sequence":"additional","affiliation":[{"name":"Catholic University of the Sacred Heart , Rome , Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Luigi","family":"Spadafora","sequence":"additional","affiliation":[{"name":"Department of Medical-Surgical Sciences and Biotechnologies, Sapienza University , Rome , Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Giuseppe","family":"Biondi-Zoccai","sequence":"additional","affiliation":[{"name":"Department of Medical-Surgical Sciences and Biotechnologies, Sapienza University , Rome , Italy"},{"name":"Mediterranea Cardiocentro , Napoli , Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9065-3261","authenticated-orcid":false,"given":"Roberto","family":"Nerla","sequence":"additional","affiliation":[{"name":"Maria Cecilia Hospital, GVM Care & Research , Cotignola , Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fausto","family":"Castriota","sequence":"additional","affiliation":[{"name":"Maria Cecilia Hospital, GVM Care & Research , Cotignola , Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Domenico","family":"D'Amario","sequence":"additional","affiliation":[{"name":"Dipartimento Universitario di Medicina Traslazionale, Universit\u00e0 Piemonte Orientale, Azienda Ospedaliero-Universitaria Maggiore della Carit\u00e0 di Novara , Novara , Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5156-7723","authenticated-orcid":false,"given":"Davide","family":"Capodanno","sequence":"additional","affiliation":[{"name":"Division of Cardiology, Azienda Ospedaliero Universitaria Policlinico \u2018G. Rodolico-San Marco', University of Catania , Catania , Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0403-3726","authenticated-orcid":false,"given":"Young-Hoon","family":"Jeong","sequence":"additional","affiliation":[{"name":"CAU Thrombosis and Biomarker Center, Chung-Ang University Gwangmyeong Hospital , Gwangmyeong , Republic of Korea"},{"name":"Department of Internal Medicine, Chung-Ang University College of Medicine , Seoul , Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5665-4076","authenticated-orcid":false,"given":"Takeshi","family":"Kimura","sequence":"additional","affiliation":[{"name":"Division of Cardiology, Hirakata Kohsai Hospital , Osaka , 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