《国际循环》：PCI 围手术期抗凝治疗期间，对这两种药物应用的推荐是什么？

    <International Circulation>: What are recommendations for the use of those two during periprocedural anticoagulation therapy?

    Dr Dangas：在ST段抬高MI患者中，最佳的围手术期抗凝是通过在救护车或急诊室中首次接触患者时即早期给予一次肝素注射，继而在直接PCI之际在导管室中确定一种比伐卢定方案，禁用华法林。在我的报告中指出，“使用护士抽屉里已有的药物，如果它能完成这项工作”，不要花费数小时等待从药房中取回的一种药效轻微或略微有效的药物。肝素充分满足上述标准，正因如此，在就诊初期，我认为它是有效且更实用的药物。随后当患者进入导管室，继而可以给予更细致的治疗，因为在那里一切都有。
    Dr Dangas: In the patient with ST elevation MI， the best periprocedural anticoagulation is achieved by administering an early bolus of heparin at the time of first contact with the patient in the ambulance or emergency room， followed up by establishing a bivalirudin regimen in the cath lab at the time of the primary PCI. Warfarin is contraindicated. I said in my talk， “Use what your nurse has in the draw if that can do the job”. Don’t wait for a minimally or marginally superior agent that may take hours to retrieve from the pharmacy. Heparin certainly fulfills the abundancy criteria so that is why I think it is much more practical that this agent is made available during the initial presentation. Later on when the patient goes on to the cath lab， then more refined therapies can be administered because everything is available there.