<International Circulation>: What is your opinion on DAP duration being individualized according to different types of drug-eluting stents?
　　Dr Becker: The emerging data would support that. The newer generation of drug-eluting stents allow endothelialization and endothelial cells are wonderful antithrombotics in themselves so it does seem that the newer generation of drug-eluting stents will only require six months of dual antiplatelet therapy whereas prior generations dictate a mandate of twelve months or even longer.

　　《国际循环》：您对根据药物洗脱支架的类型来对DAPT时间进行个体化怎么看？
　　Becker教授：新一代的药物洗脱支架（DES）给予充分的内皮化，且内皮细胞对抗栓治疗反应良好，所以，新型DES双联抗血小板治疗的时间只需6个月，而以前的老一代的支架需要12个月或更长时间。

　　<International Circulation>: Recently a randomized trial showed that in patients with high platelet reactivity after drug-eluting stent implantation， prasugrel had more effective platelet inhibition compared to clopidogrel. What information do you get from that?
　　Dr Becker: I think it is particularly important that we are able to tailor therapies， meaning if we know that a particular patient has heightened platelet reactivity that there might be a particular drug that would be best for them. We considered， at least in the past， when we had just one drug that we would hope all patients would respond but now because we have a greater number of drugs and the techniques that we use to gauge how active their platelets are have evolved， I think we are getting closer to being able to individualize care. I would expect that as the technology evolves that our pharmacological based therapies will evolve with it so it is upon us to do the appropriate designed trials so we can get the answer and not necessarily make assumptions based on prior experience.

　　《国际循环》：最近一项随机化试验表明，血小板高反应性患者置入DES后，与氯吡格雷相比，普拉格雷能更有效地抑制血小板。您的观点是什么？
　　Becker教授：我认为，给予个体化治疗是非常重要的，这意味着如果我们知道患者有血小板反应性增加，可能会有一种特定药物最适合。我们认为，至少在过去是这样想的，当只有一种药物时，我们会希望所有患者都对治疗有反应，但是因为现在我们有很多种药物，另外我们用来测量患者血小板活性的技术也不断进展。我认为，我们离个体化治疗越来越近了。我期望，随着技术的进步，以药物为基础的治疗也会随之进展，开展设计合理的试验取决于我们自己。通过试验我们就能够够找到问题的答案，而不一定要靠过去的经验来提出假设。

　　<International Circulation>: It has been demonstrated by a series of trials that direct thrombin inhibitors have a lower risk of hemorrhage and don’t increase cardiovascular events compared to unfractionated heparin (UFH) and low molecular weight heparin (LMWH). Will it replace UFH and LMWH in the near future?
　　Dr Becker: It really depends on the indication. We certainly have trials of direct thrombin inhibitors in acute coronary syndromes previously but none of them led to approval in acute coronary syndromes. We do have one drug， bivalirudin， which is approved for patients undergoing percutaneous coronary intervention and in that particular setting， its safety profile and efficacy profile has certainly driven uptake.

　　《国际循环》：一系列试验显示，直接凝血酶抑制剂较普通肝素和低分子肝素导致出血的可能性小，同时不增加心血管事件风险。直接凝血酶抑制剂在不远的将来能否替代普通肝素和低分子肝素？
　　Becker教授：事实上这取决于适应证。当然，以往我们开展了直接凝血酶抑制剂用于急性冠状动脉综合征的临床试验，但是没有一种直接凝血酶抑制剂被批准用于急性冠状动脉综合征。我们确实有一种药物比伐卢定被批准用于接受PCI患者的治疗，该药用于PCI时良好的安全性和疗效确实促使了医生对它的广泛使用。