《国际循环》：双联抗血小板治疗和围手术期抗凝导致出血并发症风险增加。在降低出血风险的同时，我们如何恰适使用这些治疗方案？

    <International Circulation>:  Dual antiplatelet therapy and periprocedural anticoagulation causes an increased risk of bleeding complications. How can one appropriately apply these treatment therapies while reducing the risk of bleeding?

    Dr Dangas：第一，从一开始，对缺血风险高的患者你就可以采用强化治疗。以体重、性别、既往卒中史和其他因素为基础，尝试评估那些处于低 和高出血风险患者，更为重要的是，据此调整给药时间。在某些情况下，我发现，给予非常有效的药物，譬如普拉格雷，仅一个月，就非常有用。这样，在你认为随后可能有出血风险的患者中，如有关于溃疡或类似情况的担忧，在家庭和医生的监督下，治疗一个月，就可以有很好的疗效。但是，在成功治疗一个月后，若患者移至一个遥远的地方或一个不能实现密切随访的区域，可改用一种较为温和且安全的长期治疗药物。治疗方案的实用性尤为重要，因为最终是患者、医生以及患者家人管理患者的生活，以便规范用药、随访以及与医疗保健提供者进行沟通。如果中断上述3种非常简单的事情，那么基本上你就是在盲目用药，只会增加并发症。在所有的ST段抬高MI的治疗中，时机非常重要。当我们在给予药物治疗时，若可以调整这一时机，那么我们就会获益更多。

    Dr Dangas: Number one， from the outset， you can apply the intense therapies to the high risk of ischemic risk patients. On the basis of body weight， gender， previous stroke history and other factors， try to assess those who are at low versus high bleeding risk and ultimately， and more importantly I think， we can modify the duration of administration of the therapies. In certain cases I find it quite useful that you administer very potent agents， such as prasugrel， but only for a month. In this way， in patients who you think may have a bleeding issue later on in time， if there are concerns of an ulcer or something similar for example， under a lot of supervision of family and doctors for a month， they can do well but after a successful month can switch to a more modest safety long-term therapy when the patient moves on to a remote location or an area where a close follow-up may not be as practical. The main message is that the practical aspects of selecting the regimens as well as the patients is very important because ultimately the human beings are the patients and the doctors and families are going to have manage their lives in order that medications are taken， follow-ups occur and communication happens with healthcare providers. If those three very simple things break

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