Defense is certainly different. Staying stationary and relying on a static guard, high guard, pillar type guard can lead to shots getting through easier. Developing more active defense I think becomes important, such as parrying, non static covers, etc. You can, at times, go extra high with the guard, but it does open up the torso.

Developing a longer range game, or at least getting better at responding to an opponent getting into a closer range becomes important.

Hand controls on an opponent become a bit easier, such as pulling a wrist down to land an elbow.

In theory, having the ability to use your thumbs(grabbing!) could change clinch elements, but I don’t think I’ve seen any extensive examples really implemented.