<International Circulation>: What kind of oral anticoagulant (OAC) treatment would you suggest?
　　《国际循环》: 您建议用什么样的口服抗凝剂(OAC)进行治疗?
　　Prof Vardas: Again， our guidelines recommend following this policy. If you have a patient with AF， paroxysmal or permanent， and this patient is properly treatment with vitamin-K antagonists that means that the INR will be consistently between 2 and 3 and if the patient has no problems with food， then the guidelines suggest leaving this patient with vitamin-K antagonists (VKA). On the other hand， some patients are not happy with VKA. As you know， VKAs， such as warfarin， have a very narrow therapeutic window and many patients have difficulty eating vegetables， or they do not like to visit the biochemistry department or the anticoagulation clinics every second week to standardized there INR time. In these cases， a NOAC， like dabigatran or rivaroxaban is indicated. In the new guidelines we have suggested that in the new AF patients， those who are na?ve to AC treatment， we have to start treating with the NOAC like dabigatran or rivaroxaban.
　　Vardas教授: 关于这点，我们的指南也推荐了以下的一些策略。如果你的病人， 他患了房颤， 阵发性或持续性的，如果这个病人用维生素k拮抗剂进行正确治疗，意味着INR将维持在2至3之间，如果吃食物没有问题，，指南建议这个病人继续进行用维生素k拮抗剂(VKA)进行治疗。另一方面， 有些病人不喜欢用VKA。你知道， VKAs， 如华法林， 有效治疗的窗口窄， 很多病人在吃蔬菜方面有困难，并且他们不愿意每两周去生化部门或抗凝治疗诊所进行检测，以维持INR在治疗的标准范围以内。在这种情况下，一种非口服抗凝剂（NOAC）问世了， 像dabigatran（达比加群）和rivaroxaban（利伐沙班）。 在新的指南中建议那些一开始就用口服抗凝剂进行治疗的新的房颤患者， 我们不得不开始用非口服抗凝剂像达比加群或利伐沙班进行治疗。
　　<International Circulation>: What are some your opinions of rivaroxaban and its future potential?
　　《国际循环》: 对于rivaroxaban（利伐沙班）及其未来的潜力您有怎样看法?
　　Prof Vardas: We have dabigatran and rivaroxaban at the moment. Apixaban is coming and was just recently approved by the EMA， but not yet by the FDA. There are some clear messages from the large clinical trials like RELY and ROCKET AF that refer to dabigatran and rivaroxaban. Both drugs seem effective at reducing the risk of hemorrhagic or ischemic stroke. As you know， there are some differences in the mechanism and action of these drugs. Also， there is a big difference in that dabigatran is used twice daily， while rivaroxaban is only used once. However， both drugs are quite effective. Probably dabigatran is more effective at a dose of 150 mg twice daily to prevent ischemic stroke. We have to see over the next few years how these two drugs will behave.
　　Vardas教授: 此刻我们已经有了达比加群或利伐沙班。现在又有了阿哌沙班，最近已经得到EMA的批准，但尚未被FDA批准。在大型临床试验比如RELY和ROCKET AF中我们已经得到关于dabigatran（达比加群）和rivaroxaban（利伐沙班）的一些明确的信息。这两种药物都可以明显的降低出血性或缺血性卒中的风险。你知道，这两种药物的作用机制有一些差异。同样，在使用上也有很大的区别，dabigatran（达比加群）每日两次， 而rivaroxaban（利伐沙班）只使用一次。然而，这两种药物同样是非常有效的。在防止缺血性中风方面，服用dabigatran（达比加群）的剂量为150毫克，每日两次，可能更加有效。这两种药物在未来的几年中将发挥怎样的效果，我们拭目以待。