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In Reply Dr Jeong and colleagues raise important issues regarding the ethnic variability in response to antithrombotic treatments, emphasizing the importance of studying such therapies in different populations. We agree that East Asian patients have different responsiveness to antithrombotic therapy compared with white patients.
Paradoxically, despite higher prevalence of CYP2C19 loss-of-function alleles and higher on-treatment platelet reactivity after P2Y12 inhibitor treatment, East Asian patients have comparable or lower rates of stent thrombosis and major adverse cardiac events but greater tendency to bleeding than white patients, the so-called East Asian paradox. In addition to (known and unknown) genetic differences, variations in environmental influences, interventional practices and adjunct pharmacology, drug compliance, and other factors may contribute to this observation.
Han Y, Li Y, Stone GW. Varying Responses to Antithrombotic Treatment by Race/Ethnicity—Reply. JAMA. 2015;314(6):625. doi:10.1001/jama.2015.7384