< International Circulation>: As the president of the 21st International Congress of Thrombosis 2010， could you introduce some of the main features of the congress? Compared with previous congresses are there any highlights or special features this year?
作为2010年第21届国际血栓大会的主席，您能否向我们介绍一些大会的主要特点吗？与以前的会议相比，本届是否有哪些热点或不同之处？
Prof. Mannucci: There is no doubt that this congress， which is not held very frequently， is really a very cogent moment of great developments in the field of thrombosis; not so much in the mechanism， but in the treatment of thrombosis. New antithrombotic drugs are being developed and as you can see from the title of the congress， “A New Era for Antithrombotic Agents，” that the congress really featured these new developments. There are new anticoagulants with some peculiar features that represent an improvement even though they are still in an early phase of development and also new antiplatelet agents.
毫无疑问，国际血栓大会的召开并不频繁，但它却令人瞩目的展示血栓疾病领域重大进展的时刻其重点并非是在机制方面，而是重在血栓疾病的治疗。新的抗栓药物正在不断发展，从本次大会的主题—— “抗血栓药物的新纪元”，也表明新进展是本届的大会的主要特点。尽管仍处于研究早期阶段，但确实有一些新的具有独特特征的确代表新发展的抗凝药，和抗血小板药物。
< International Circulation>:New anticoagulant and antiplatelet agents， oral factor Xa inhibitors and thrombin receptor antagonists， for example， are the main features of this congress. Can you discuss the latest progress in these fields?
新的抗凝药物和抗血小板药物，如口服Xa因子抑制剂和凝血酶受体拮抗剂，是本次会议的主要特点。您可以介绍一下该领域的最新进展吗？
Prof. Mannucci: These agents satisfy some unmet needs in the field. I am not saying that the currently available drugs are not effective， because LMWH and oral anticoagulants are very effective and dramatically reduce the incidence of venous thrombosis， embolism due to atrial fibrillation， and they are also part of the armamentarium that is being used in ACS with revascularization. Therefore， I do not want to deny the importance of these drugs but they certainly have some limitations. For instance， in the prevention of venous thromboembolism the low molecular weight heparins and also fondaparinux must be given subcutaneously. This is an obstacle， particularly in the elderly when they are discharged from the hospital and they need to continue prophylaxis at home because they are still at risk of developing thrombosis. Unfortunately， not all of these patients are able to have someone who can give subcutaneous injections and these drugs can only be given either intravenously or subcutaneously. Thus， to have an oral agent that does not need to be monitored is really a big step forward. It is in these indications that these drugs are officially licensed both in Europe and the United States. Thus， for prevention of venous thromboembolism these new agents are not necessarily more efficacious but they are certainly much more practical and this leads to an improvement in treatment due to more compliance. I very frequently see when these elderly patients who have issues with cognition go home from the hospital and they are alone and frail have a lot of problems implementing prophylaxis for 40 days.
这些药物满足了该领域一些我们以前未被满足的需求。我不是说当前使用的药物是无效的，因为低分子肝素（LMWH）和口服抗凝血药非常有效，显著降低了静脉血栓形成和房颤所致栓塞的发病率，他们还是目前ACS患者血管重建治疗中的重要组成部分。因此，我并非是要否认这些药物的重要性，但它们的确存在一定的局限性。例如，在静脉血栓栓塞的预防中，LMWH及磺达肝素必须皮下给药。这会造成一些困难，尤其是对哪些出院后因为仍然存在发生血栓风险而需要在家继续进行预防治疗的老年人。不幸的是，并非所有患者身边都有人可以帮他们进行皮下注射，而这些药物只能通过静脉或皮下给药。因此，拥有一种不需要监测的口服药物会是一项巨大进步。这些药物在欧洲和美国已经获得批准用于这些适应证。因此，对预防静脉血栓形成，这些新药不一定更为有效，但它们的确实更加实用，且有助于改善治疗依从性。我经常看到一些老年患者因为有认知障碍、生活孤独而又身体虚弱出院回家后不能完成为期40天的预防治疗。
The congress showed that there are also other drugs besides rivaroxiban and dabigatran that are effective. I would particularly like to mention apixaban， which is a factor Xa inhibitor. It is not yet licensed and it is not yet clear which of these agents is most effective as they have not yet been compared head to head but they are at least as effective as LMWH and fondaparinux and have the advantages that I mentioned.
本次大会还展示了除利伐沙班和达比加群外的其他有效药物。我尤其要提到阿哌沙班，它是一个Xa抑制剂，尚未获得批准上市。由于还没有进行头对头的比较，尚不清楚这些药物中哪种是最有效的，但是至少它们像LMWH和磺达肝素钠一样有效，并且具有我所提到的那些优点。
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