International Circulation: There has been a lot of excitement in China about determining who is likely to bleed using platelet function testing and genetic polymorphism. How do you evaluate the value of platelet function testing in the prediction of thrombus risk and decisions about DAPT duration?
　　Dr Mehran: There have been a couple of trials come out that have not said much. We have the ADAPT-DES Study that showed in all-comers that the rates of ischemic complications were so low with the new generation DES， that using platelet function studies to figure out if a patient is resistant to clopidogrel and changing them to an alternative therapy would require 20000-30000 patients and is it really worth doing on this basis. Does it make sense in terms of cost-effectiveness? Right now， although you can perform them in certain cases， I don’t think it is cost-effective based on the clinical studies available to prescribe those kinds of tests， both genetic polymorphism tests and platelet function tests， in all patients. I do think it would be nice to be able to risk stratify patients using those modalities if they didn’t cost so much. We always have to think about the dollar signs in the equation as well.
　　《国际循环》：在中国很多医生热衷于使用血小板功能检测和基因多态性来确定哪些患者出现几率大。您认为在预测血栓风险和决定DAPT疗程方面，心血管功能检测的价值如何？
　　Dr Mehran: 已有数项试验公布了结果，但有价值的信息非常有限。ADAPT-DES试验显示，在全来源受试者中，新一代DES置入后缺血性并发症的发生率非常之低，以至于采用血小板功能检测需要20 000~30 000例患者才能识别出1例氯吡格雷抵抗患者，然后给予其替代治疗，这是否值得？考虑到成本效益，这样做还有无价值？就目前而言，你可以对特定的病例进行这些检查；基于已有的临床试验结果，我认为对所有患者进行基因多态性检测和血小板功能检测等检查，不具有成本效益的价值。我反倒认为，如果这些检查不那么昂贵，用来进行危险分层应为很好的想法。我们不得不总是考虑到钱的问题。
　　International Circulation: With regard to triple therapy， one of the contentious points seems to be how safe the new DES are and when you can indeed stop using them. What is your opinion on the topic?
　　Dr Mehran: I am very excited about the data that is coming out with the everolimus-eluting stents and the fluropolymers and whether or not we can take a chance and give a shorter duration of therapy to patients who deserve and should get DES. We need to do a larger randomized clinical study as I always say for any kind of major recommendation like that and especially to shorten the duration of treatment. I think a country like China can really give us a tremendous insight by the vast number of patients in this country and the incredible clinicians who are devoted to clinical research. I am hoping that we could set up and design a study that could be done here in China， looking at a shorter duration versus a longer duration with the new drug-eluting stents.  That to me is exciting and worth pursuing.
　　《国际循环》：干预三联疗法的争论焦点之一在于新型DES的安全性如何，以及何时可以停药。您对此有何看法？
　　Dr Mehran: 已经公布了依维莫司洗脱支架和含氟聚合物以及对应该置入DES的患者能否给予更短疗程的抗血小板治疗的研究数据，我对此感到非常兴奋。正如我经常强调的，对于我们要作出的任何重要建议，尤其是缩短治疗疗程的建议，都需要实施大型的随机化临床研究以获取证据。我认为像中国这样的国家可以给我提供十分广阔的视角，因为这里有如此巨大的患者数量，有不计其数的临床医生在参与临床研究。我非常盼望能够着手设计一项能够在中国进行的研究，在置入新型药物洗脱支架的患者中对比短疗程和更长疗程的结果。这是令我兴奋和值得寻求合作的事情。

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