Internet Circulation:  Would you please share your experience on the anticoagulation for ST-Segment Elevation Myocardial Infarction (MI) and what’s your opinion on the outcome of the OASIS-6 trial?

国际循环：请您给我们介绍一下关于ST段抬高心肌梗死（MI）抗凝治疗的经验，您对OASIS - 6试验的结果有何看法？

Professor Weitz: For ST-segment elevation MI most patients in North America end up going for primary PCI.  If they go to the CATH lab directly to have their coronary artery opened then we use unfractionated heparin.  If they go to the CATH lab that is what the treatment of choice is.  If they don’t go to the CATH lab then I suppose fondaparinux is a good， reasonable choice.  It may also be a reasonable choice if they get a lytic agent like TPA or streptokinase.  I don’t know if in China cardiologists do a lot of thrombolysis or not but if you do thrombolysis then fondaparinux might be a treatment of choice.  The OASIS-6 trial told us that if patients go directly to the CATH lab then fondaparinux is not the treatment to use.

Professor Weitz：对于ST段抬高心肌梗死，北美大部分患者最后进行PCI。如果他们到心导管实验室直接进行冠状动脉扩张，则常常使用普通肝素。如果他们不去心导管实验室的话，我认为磺达肝癸钠是一个很合理的选择。此外，TPA或链激酶也是一个合理地选择。我不知道中国心脏病学家是否常常进行溶栓治疗，如果进行溶栓那么磺达肝癸钠可能是一个治疗选择。OASIS - 6试验告诉我们，如果病人直接到心导管实验室，那么就不会用磺达肝癸钠进行治疗。

Internet Circulation:  In China we sometimes use fondaparinux for cases of pulmonary embolism.

国际循环：在中国，我们有时会使用磺达肝癸钠治疗肺栓塞。

Professor Weitz:  Yes， here in the United States might use fondaparinux for pulmonary embolism or deep vein thrombosis but we more often use low molecular weight heparin.

Professor Weitz：是的，在美国可能使用磺达肝癸钠治疗肺栓塞或深静脉血栓形成，但我们更多地使用低分子量肝素。

Internet Circulation:  Please talk about the anticoagulants that could be selected and its effects on atrial fibrillation patients in clinical practice?

国际循环：请您谈谈可以选择的抗凝血药有哪些，及其在临床应用中对心房颤动患者的疗效？

Professor Weitz:  In atrial fibrillation what we first do is assess the patient’s risk for stroke and we typically use the CHADS II score to do that.  Patients who are at low risk for stroke either get nothing or aspirin， while patients at higher risk should get an anticoagulant， typically the anticoagulant that is used is warfarin.  With the recent RE-LY trial that was just presented at the ESC meeting we are hoping that the dabigatran might be another choice in place of warfarin for these patients.  I know dabigatran is not in China because it is not approved anywhere in the world yet for atrial fibrillation.

Professor Weitz：对于房颤，我们首先要做的就是评估患者中风的风险，我们通常使用CHADS II评分。对于低卒中风险患者可以不给予任何药物或仅给予阿司匹林，而对高风险患者应给与抗凝血药，通常使用华法林。最近刚刚在ESC会议上报告的RE-LY试验显示达比加群酯可能替代华法林用于这类患者的治疗。我知道在中国达比加群酯尚未上市，因为世界上还没有任何国家批准其用于心房颤动的治疗。

Internet Circulation:  Please talk about your experience on unfractionated heparin and Fondaparinux treatment in elderly patients with non-st-elevation acute coronary syndrome or MI?

国际循环：请您谈谈普通肝素和磺达肝癸钠治疗非ST段抬高急性冠脉综合征或MI老年患者的经验？

Professor Weitz:  Again， for non-ST elevation MI， if patients are not going to the CATH lab than fondaparinux is a reasonable choice.  If they do go to the CATH lab then unfractionated heparin would be a better choice.

Professor Weitz：同样，对非ST段抬高MI患者，如果不是去心导管实验室，那么，磺达肝癸钠是一种合理的选择。如果他们去心导管实验室，普通肝素将是一个更好的选择。

Internet Circulation:  Would you please give some advice with us on the bleeding risk and bleeding management during anticoagulant therapy?  Some anticoagulants such as warfarin have antidotes.

国际循环：您能给我们一些关于抗凝治疗过程中出血风险和出血管理的建议吗？一些抗凝血药如华法林有解毒剂。

Professor Weitz:  A lot of anticoagulants do not have antidotes so warfarin has an advantage in this case.  It does however depend on what is being treated， on when you need the antidote， and how fast you need it as well as what the half-life is.  We have antidotes for heparin and partial antidotes for low molecular weight heparin but we do not have antidotes for fondaparinux nor for some of the new oral anticoagulants.  That is going to be a problem if patients have massive bleeding or if they require an urgent intervention.  We are going to have to work out ways to manage that.  For example， for dabigatran the taxolite dialysis might work.  Dialysis will not work for rivaroxaban.  These are things we are going to have to explore in the future or the use of pro-coagulants like recombinant factor 7a we don’t know how well it works.  We are just going to have to continue doing more studies investigating these issues.

Professor Weitz：很多抗凝血药没有解毒剂，而这正是华法林的优势。但是它依赖于治疗的疾病以及何时需要解毒药，多快需要以及半衰期多长。目前已有肝素解毒药和低分子肝素部分解毒药，但还没有磺达肝癸钠解毒药以及一些新口服抗凝血药的解毒药。如果患者发生大量出血或需要紧急干预，这将是一个问题。我们将想办法解决这一问题。例如，对于达比加群酯，透析可能奏效，而透析对利伐沙班无效。这些都是我们将要探讨的问题，或者使用前促凝药如重组因子7a，目前还不知道其疗效如何。对于这些问题，还需要做更多的研究。

Internet Circulation:  Anticoagulants are a mainstay of cardiovascular therapy; please talk about the current needs and future developments of anticoagulants?

国际循环：抗凝血药是心血管治疗的主体，请您谈谈有关当前需要和未来抗凝血药开发的问题？

Professor Weitz:  The biggest need is for long-term use anticoagulants.  For the past 60 years all we have had are the vitamin K antagonists like warfarin， so the development of agents like dabigatran and rivaroxaban is a major advance.  We need the clinical trials to know if these drugs are as good or better than the current vitamin K antagonists.  Recent trials like the RE-LY are great because it suggests that these agents might be better than drugs like warfarin. They are much easier to give since they don’t need to be monitored and can be give in fixed doses， making it easier for clinicians to use these new agents.

Professor Weitz：最需要的是长期使用抗凝血药。在过去60年，我们有维生素K拮抗剂如华法林，因此，开发达比加群酯和利伐沙班是一大进步。我们需要通过临床试验来验证这些药物是否和维生素K拮抗剂一样有效或者更好。最近的RE-LY试验显示这些药物可能比华法林更好。它们给药更容易， 因为并不需要进行监测，并且可以给与固定剂量，使临床医生使用起来更方便。