International Circulation: After STEMI， and patients with atrial fibrillation have undergone primary PCI， what do you think is the best use of antithrombotic drugs under primary PCI therapy?
　　《国际循环》：房颤患者出现STEMI后接受直接PCI，您认为在行直接PCI治疗的情况下最佳的抗栓药物是什么？
　　Dr. Camm: At present， in the great majority of instances， we are faced with the issue of using multiple drug therapy. For atrial fibrillation， we generally need to consider formal anticoagulation with warfarin and， as I have already suggested， with dabigatran in those places where it is available. But for PCI we need to consider both aspirin and other antiplatelet agents such as clopidogrel. If we think of all of these agents being necessary we come into the field of triple therapy and obviously this is a form of treatment which could easily be complicated by bleeding. For that reason， we like to keep the triple therapy as short as possible. Until the present time， the therapy that we have chosen is warfarin because there is much more experience with warfarin than with dabigatran. There is only a small trial in patients with acute coronary syndrome with dabigatran and there is certainly no definitive study. At present I think we would use warfarin. The patient would be on aspirin and clopidogrel or one of the drugs similar to it such as prasugrel， and we try to keep the clopidogrel treatment as short as possible. The major variables are whether the procedure is elective or acute and whether a bare metal stent is used or a drug-eluting stent. For drug-eluting stents and for emergency procedures we generally use about six months of triple therapy. If it is elective and you use bare metal stents， we can bring that down to a month or two.
　　Dr. Camm：目前，在绝大多数情况下，我们面临着采用多重药物治疗的问题。PCI后，针对房颤，我们一般需要考虑应用华法林或达比加群进行正规抗凝。但针对PCI，我们需要考虑应用阿司匹林以及其他抗血小板药物如氯吡格雷。若这些药物均为必要，就需进行三联抗栓治疗，显然这是一种易于并发出血的治疗形式。基于此，应尽可能缩短三联治疗的时间。直到目前为止，我们的选择都是华法林，因为华法林的应用较达比加群有更多的经验。仅有一项小规模的在ACS患者中使用达比加群的试验，尚无确定性的研究。目前，我们会选择华法林，同时，患者还将应用阿司匹林和氯吡格雷或一种与它相似的药物如普拉格雷治疗，且尽可能缩短氯吡格雷的治疗时间。主要变量在于是择期PCI还是急诊PCI，是应用裸金属支架（BMS）还是药物洗脱支架（DES）。对于急诊PCI置入DES的患者， 一般应用约6个月的三联治疗。对于择期PCI置入BMS的患者，可以将三联治疗时间缩短至1个月或2个月。

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