<International Circulation>: The risk stratification for acute pulmonary embolisms is far from satisfactory are there any ways we can apply to try and optimize this area concerned?

  《国际循环》：急性肺动脉栓塞的危险分层还远不能让人满意，我们可以采用什么方法来尝试并优化这一受关注领域呢？

    Prof Nicolas Meneveau: Current risk stratification is based on clinical assessment according to the presence or non presence of haemodynamic instability as well as the presence of right ventricular dysfunction by the use of an echocardiogram. This includes the detection of positive biomarkers such as the presence of troponins and the presence of BNP (Brain natriuretic peptide). We know clinical assessment works just as well in the detection of biomarkers in defining non high risk primary embolism patients. The goal of the near future is to trying to find the best way to accurately define patients who are at intermediate risk of primary embolism patients. In this setting， the future will involve combining clinical assessment that is the presence of haemodynamic instability， detection of positive biomarkers， and presence of right ventricular dysfunction by the use of an echocardiogram.

    Nicolas Meneveau教授：目前的危险分层是基于临床评估，根据是否存在血液动力学不稳定性以及超声心动图应用提示右室功能不全的存在。这包括阳性生化标记物如肌钙蛋白或脑型利钠肽（BNP）。我们知道，在确定原发性肺栓塞非高危患者上，临床评估发挥的作用如同生化标记物一样优秀。将来的目标是尝试找到准确确定原发性肺栓塞中危患者的最佳方法。在这种情况下，未来将会涉及联合临床评估即血液动力学不稳定的存在、阳性生物标记物的检出以及超声心动图应用所示右室功能不全的存在。

    <International Circulation>: The use of thrombolytic agents is controversial in intermediate risk patients. How can we optimize the management of these patients?

 《国际循环》：在中危患者中，溶栓药物应用存在争议。我们如何优化这些患者的治疗？

    Prof Nicolas Meneveau: This is a difficult question because we do not have the answer yet. The PLATO Trial should be able to answer this specific question. We know that intermediate pulmonary embolisms that are defined as normal hypertensive patients with positive troponin detection and right ventricular dysfunction from detection by an echocardiogram. We know that in this patient sub group have a poor prognosis compared to non risk or low risk pulmonary embolism patients but we do not have the answer yet whether or not these patients would positively respond to thrombolytic therapy. This is the aim of the PLATO Trial which is designed to answer this question.

    Nicolas Meneveau教授：这是一个很难回答的问题，因为我们还没有答案。PLATO试验应该能够回答这一具体问题。我们知道，中危肺动脉栓塞被定义为肌钙蛋白阳性和超声心动图提示右室功能不全的正常血压患者。与无危险或低危肺动脉栓塞患者相比，这一患者亚组预后欠佳，但这些患者对溶栓治疗是否会有积极反应我们尚无答案，此即PLATO试验的目的。

    <International Circulation>: What strategies would you recommend to prevent reoccurrence of acute pulmonary embolisms?

 《国际循环》：您推荐用何种策略来预防急性肺动脉栓塞复发？

    Prof Nicolas Meneveau: You have to monitor very closely high risk patients who have been operated on with poor mobilization and those with positive thrombophilia. Medical prevention should take into account all these risks and patients should be treated with or low molecular heparins such as enoxaparin or preferably fondaparinux because of the low risk of TIH according to this last molecule.

    Nicolas Meneveau教授：你必须非常密切地监测接受手术、活动欠佳的高危患者以及那些有阳性血栓形成倾向的患者。药物治疗预防应考虑所有这些危险，患者应以低分子肝素如依诺肝素或根据最新的数据最好用磺达肝癸钠来治疗。