<International Circulation>: Many patients are found to have atrial fibrillation after stroke. The recommendation is that patients with atrial fibrillation and previous stroke  receive long-term anticoagulation. However， the risk of hemorrhage is high to these patients. Please talk about how to offer appropriate long-term anticoagulation therapy to these patients？

 《国际循环》：卒中后，很多患者被发现患有心房颤动。推荐是，有心房颤动和既往卒中的患者接受长期抗凝治疗。然而，这些患者的出血风险高。请您谈谈对这些患者如何提供适当的长期抗凝治疗？

    Dr Deirdre Lane: Indeed， there is a common perception that patients with atrial fibrillation and a previous stroke have a higher risk of bleeding when prescribed anticoagulation therapy， but as I showed in my presentation this was not necessarily the case in the AMADEUS cohort. There was no major significance in terms of clinically relevant bleeding， major bleeding， or intracranial hemorrhage between those patients who had suffered a previous stroke and those who had not，whilst on anticoagulation. As highlighted in several presentations at this year’s ESC and the new ESC guidelines on atrial fibrillation， when deciding on appropriate anticoagulation for atrial fibrillation patients， a comprehensive assessment of the patients’ risk of stroke and their risk of bleeding needs to be undertaken.. Obviously having an ischemic stroke puts you at an increased  risk of having a subsequent ischemic stroke.  Clearly， the benefit of anticoagulation should outweigh the risk of bleeding. In addition to this we have to explain the stroke and bleeding risk to the patients so that they can make an informed choice and so that their preferences for treatment are also taken into account. Physicians and patients have differing preferences when it comes to treatment choices for anticoagulation. A physician may be less accepting of a bleed that occurs during therapy than a stroke that occurs in the absence of such therapy， whereas patients are often willing to accept a risk of bleeding to prevent a stroke       

    Dr Deirdre Lane：的确存在这样一种普遍看法，即有心房颤动和既往卒中的患者在抗凝治疗时出血风险较高，但如我在演讲中所显示的那样，在AMADEUS队列中并不一定是这样。那些经历或未经历卒中的患者在接受抗凝治疗时，临床相关出血、大出血或颅内出血无显著差异。如今年在ESC年会上几个演讲以及新的ESC心房颤动指南所强调的那样，当为心房颤动患者决定适当的抗凝时，需对患者的卒中风险及其出血风险进行全面评估。显而易见，既往有缺血性卒中史的患者发生缺血性卒中的风险高，抗凝的益处应大于出血风险。此外，我们必须向患者解释卒中和出血风险，以使他们可以做出知情的选择，因此他们对治疗的喜好也被纳入考虑范围。当谈到抗凝治疗选择时，医生和患者有着不同的偏向。与无抗凝治疗时发生卒中相比，医生可能更不能接受治疗期间发生出血，而患者常常愿意接受出血风险来预防卒中。