Ethnic Difference of Thrombogenicity in Patients with Cardiovascular Disease: A Pandora Box to Explain Prognostic Differences

Arterial and venous atherothrombotic events are finely regulated processes involving acomplex interplay between vulnerable blood, vulnerable vessel, and blood stasis.Vulnerable blood (‘thrombogenicity’) comprises complex interactions between cellularcomponents and plasma factors (inflammatory, procoagulant, anticoagulant, andfibrinolytic factors). The extent of thrombogenicity may determine the progression ofatheroma and the clinical manifestation of atherothrombotic events, with the highestthrombogenicity in African Americans and lowest in East Asians. Inherentthrombogenicity may influence clinical efficacy and safety of specific antithrombotictreatments in high-risk patients, which may in part explain the observation that EastAsians have reduced anti-ischemic benefits and elevated bleeding risk withantithrombotic therapy compared with Caucasians. In this review, we discuss availableevidence regarding the racial differences in thrombogenicity and its impact on clinicaloutcomes in patients with cardiovascular disease.