《国际循环》：对PCI 围手术期抗凝和抗血小板的决策而言，您认为危险分层的基础是什么？

   <International Circulation>: What do you think is the risk stratification basis for periprocedural anticoagulation and antiplatelet decisions?

    Dr Dangas：危险分层非常重要，我们需要了解哪位患者处于高缺血风险，而且我们应该了解哪位患者处于低、中和高出血风险。缺血风险依次为：ST段抬高MI为最高危，非ST段抬高MI、稳定型心绞痛为中危，稳定性患者则处于低危。为决定给予何种药物，高危缺血的ST段抬高MI患者可应用出血的危险分层。根据年龄和体重等标准，普拉格雷可用于低出血风险患者。对于高出血风险的ST段抬高MI患者，氯吡格雷更为可取。对于中危出血患者，可以细化两种治疗中的任一种，或使用双倍剂量的氯吡格雷，或依据患者的临床特征，给予1个月的普拉格雷，继而改为长期氯吡格雷口服。
    Dr Dangas: The risk stratification is very important and we need to understand which patients are at high ischemic risk and we should understand which patients are at low， intermediate and high bleeding risk. Ischemia risk is primarily assigned to ST elevation MI as being the highest risk and non-ST elevation MI， stable angina and the intermediate and stable patients are in the low risk category. ST elevation MI high risk for ischemia patients can use the bleeding stratification in order to decide between the various agents. Prasugrel can be used in patients with low bleeding risk according to the criteria of age and body weight and so on. For the high bleeding risk patients， clopidogrel would be more preferable in ST elevation MI. For intermediate risk， one could refine either of the two therapies， either by doubling the clopidogrel or by administering the prasugrel for only one month and then switching to long-term clopidogrel therapy depending on the clinical criteria for such patients.

  《国际循环》：在应用这种风险评估中您有何经验？
    <International Circulation>:  What is your experience in using that risk assessment?

    Dr Dangas：迄今为止，我认为上述治疗方案是优秀的，我一直在使用。
    Dr Dangas: I think it is excellent so far and I use it all the time.

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