George D. Dangas  美国纽约西奈山医院  

《国际循环》：PCI围手术期抗凝治疗仍存在争议。您对华法林和肝素在整个围手术期阶段的应用有何建议？

    <International Circulation>: Periprocedural anticoagulation therapy remains controversial. What is your advice on the use of warfarin and heparin throughout the periprocedural phase?

    Dr Dangas：首先，华法林通常在导管插入术前几天停药，因为它是一种口服的长效抗凝剂，可能与鞘管拔除时的出血并发症相关。肝素一直是金标准，最近随着静脉注射比伐卢定方案的出现，地位进一步提升，尤其是用于ST段抬高MI患者中时，经HORIZON试验和其他几项研究验证，正是如此。

    Dr Dangas: First of all the warfarin is usually interrupted a few days before the catheterization procedure because it is an oral and long-acting anticoagulant that can be associated with bleeding complications at the time of sheath removal. Heparin has been the gold standard and has recently been improved with the advent of the intravenous bivalirudin regimens and particularly where used in the ST elevation MI patient as tested in the HORIZON trial and several other studies.