Juan Carlos Kaski  英国圣.乔治大学 冠状动脉疾病研究中心 主任

International Circulation: For the patient with chronic renal function failure and ACS， what should be paid attention to in medical treatment especially anticoagulant therapy?

《国际循环》：对于ACS合并慢性肾功能衰竭的患者，在药物治疗方面有什么特别需要注意的，特别是抗凝治疗方面？

Professor Kaski: In those patients there is a high risk of developing acute events， so all the measures that are effective in patients with coronary artery disease should be tried in these people. There are not many studies with large numbers of patients with renal disease or chronic kidney disease that can give us a very clear cut answer to what interventions we need to carry out. So we need to at least implement those that we know are effective in other subgroups of patients with high risk of coronary artery disease. Anti-platelet， Anti-thrombosis may be indicated in this sub-group of patients perhaps. Statin treatment unfortunately has not been shown to be that effective but I think that it still should be part of the treatment. There have been a number of trials planned to try and answer this question in a more categorical way.

Kaski教授：此类患者急性事件的发生率高，因此凡是对冠状动脉疾病患者有效的所有治疗措施都应在这些人中尝试使用。目前没有大量有关肾脏疾病或慢性肾脏疾病的临床研究，可以给我们一个很明确的答案，告诉我们该怎么做，所以我们至少要尝试使用那些对冠状动脉疾病高风险亚组患者有效的措施，抗血小板、抗血栓治疗等。他汀类药物治疗还未被证明是有效的，但我认为它仍然应该作为治疗的一部分。已经有许多临床试验试图明确的回答这些问题。

International Circulation: What is your experience with anticoagulation in ACS patients?

《国际循环》：请您谈谈对ACS患者抗凝治疗的经验？

Professor Kaski: That is an absolutely vital intervention. We started with aspirin， then clopidogrel， then prasugrel， all of these drugs have been shown to be quite effective in blocking platelet activity and of course we have a number of heparin which again has shown to be useful in reducing mortality in people with acute coronary syndrome. Acute coronary syndrome is a condition where the formation of a clot is vital and it is necessary to block the formation of the clot and stop its progression to prevent occlusion of the artery. The use of these anti-platelet and anticoagulant drugs is quite important to minimize these events.

Kaski教授：这（抗凝治疗）是一个非常重要的干预。我们可以使用阿司匹林、氯吡格雷，也可使用普拉格雷，这些药物都被证明能相当有效的抑制血小板活性。当然我们也使用肝素有效降低急性冠脉综合征患者的死亡率。急性冠脉综合征的关键是血栓形成，因此有必要防止血栓形成，阻止血栓进展以防动脉阻塞。使用抗血小板和抗凝药物是非常重要的，以尽量减少这些事件的发生。

International Circulation: Which LMWH would you normally choose to use in ACS patients?

《国际循环》：对ACS患者通常你会选择使用哪种低分子量肝素？

Professor Kaski: There is good data for a number of the LMWHs. The most recent compound， fondaparinux， has been shown to be also effective in a number of studies. Dalteparin has also been shown to be effective. So in general， the use of LMWHs has been associated with very good outcomes.

Kaski教授：研究已证实许多低分子量肝素都有良好效果。最新的药物磺达肝癸钠在一些研究中已被证明也是有效的。达肝素（Dalteparin）也被证明是有效的。因此，一般来说低分子量肝素使用的效果都是非常好的。

International Circulation: What is your opinion on the new anticoagulant drugs such as the oral anticoagulant drugs and Xa inhibitors? Are there good prospects for these drugs?

《国际循环》：您对新的抗凝药物，比如口服抗凝剂和Xa因子抑制剂有什么观点？这些药物的前景如何？

Professor Kaski: Yes. There are great expectations for the new oral anticoagulants and the preliminary results are quite encouraging. We are going to see more data presented at the end of the year by the American Heart Association and very promising results with these new drugs.

Kaski教授：新型口服抗凝剂有很大的应用前景，初步研究结果相当令人鼓舞。我们将看到在今年年底美国心脏协会为此提出的更多数据以及这些新药非常令人期待的好结果