Frans Van de Werf，UZ Leuven，Belgium

<International Circulation>: Last year， ESC and ACC/AHA published Guidelines for the diagnosis and treatment of non-ST-segment elevation acute coronary syndrome successively. What are the new recommendations with regard to antithrombotic treatment?

Prof. Frans Van de Werf：I think the most important aspect of the new ESC guidelines on non-ST elevation of acute  coronary syndromes is the difference in antithrombotic treatment according to the strategy which is decided upon. If it is a very invasive strategy we go for antithrombins like unfractionated heparin or enoxeparin.  On the other hand， if a more conservative approach is indicated and the patient will not undergo an early invasive strategy the ESC within the first 24 hours the ESC guidelines recommend fondaparinuxas the antithrombin because of the reduced risk of bleeding complications. 

<International Circulation>: What  factors should be considered when we weigh risk and benefit of antithrombotic therapies in acute coronary syndromes?

Prof. Frans Van de Werf：The most important risk factor for major bleeds is age. Second is the presence of renal failure and female gender. Both are associated also with a higher risk of bleeding complications.  What’s important to note is that these factors are also risk factors for ischemic complications.  If a patient， for example， dies after a major bleed it’s not always possible to know whether it is due to the bleeding complication alone or also to the poor hemodynamic condition or severe coronary lesions.