<International Circulation>: Could you please discuss the latest anticoagulation agents? Do they have the potential to replace warfarin in anticoagulation therapy for AF?
    Prof. Lip:That is a very important question because these are very exciting times. We have had anticoagulation therapy with the vitamin K antagonists such as warfarin for a very long time but it is inconvenient， needs monitoring， and there is a degree of what is called “disutility” with warfarin due to its limitations. We now have new anticoagulants that belong to the two broad classes – the direct thrombin inhibitors and oral factor Xa inhibitors.

    For the direct thrombin inhibitors we have stunning data from the RE-LY trial with the oral direct thrombin inhibitor dabigatran. This certainly shows that it is effective therapy， very safe， and less intracranial hemorrhage compared to warfarin. In this meeting of the ESC， we have also seen excellent data from the AVERROES trial with the oral factor Xa inhibitor apixaban in the context of treatment of patients who have either failed warfarin therapy or declined warfarin therapy. Current practice under the older guidelines is that if patients can not take warfarin they are prescribed aspirin. I think that the AVERROES trial has clearly shown that this is inferior therapy and treatment with an anticoagulant such as apixaban is probably better tolerated or as safe as giving these patients aspirin. Thus， the new ESC Guidelines published at this meeting stress that oral anticoagulation therapy is the best treatment for stroke prevention in AF. Furthermore， we should be moving away the artificial categorization to low-risk， moderate-risk， and high-risk strata and there should be much more emphasis on a risk factor-based approach to providing thromboprophylaxis for stroke prevention in AF.

  《国际循环》：最近有哪些抗凝药物您比较感兴趣？这些药物是否有潜力替代华法林用于房颤的抗凝治疗？
    Lip教授：这是一个非常重要的问题，我们所处的时代不断有新惊喜出现。维生素K拮抗剂华法林作为抗凝药物已经应用了很长时间，但是华法林用药不方便，需要监测。由于华法林的上述局限性，使得存在某种程度上的华法林“无效”。目前有两类新型抗凝药物：直接凝血酶抑制剂和口服因子Xa抑制剂。在直接凝血酶抑制剂方面，有来自RE-LY试验的达比加群的非常好的数据，显示达比加群的确是非常有效的治疗，同时具有良好的安全性，颅内出血的发生率显著低于华法林。在本届ESC年会上，我们看到口服因子Xa抑制剂阿哌沙班来自AVERROES试验的很好的研究结果，用于华法林治疗无效或未接受华法林治疗者。在目前的临床实践中，如果患者不能应用华法林的话，依据旧版指南就给患者应用阿司匹林。我认为，AVERROES试验清楚地证实阿司匹林并不是优选治疗。阿哌沙班等抗凝药物耐受性更好或者安全性与阿司匹林相仿。在本届ESC年会上公布的新指南强调抗凝治疗是预防房颤患者卒中发生的最佳手段。我们应当从低、中和高危的人为危险分层转向依据危险因素给予抗栓药物以预防房颤患者的卒中发生。

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