<International Circulation>: With regard to dual anti-platelet therapy after PCI， how long should clinicians maintain anti-platelet therapy after PCI?

  《国际循环》：关于PCI术后双重抗血小板治疗，临床医生应该维持抗血小板治疗在PCI术后多久？
    Prof Antman: When we deploy a stent in a patient who has coronary artery disease， we give them dual anti-platelet therapy. If it is a bare metal stent， we keep up the dual anti-platelet therapy for just a few months. Right now， we try to keep dual anti-platelet therapy going for up to one year in patients who have a drug-eluting stent because we are very concerned about the possibility of late-stent thrombosis. We are getting reports that go in two different directions. We see some reports that tell us we don’t need to give it for more than a year， in fact you may not need to give it even for a full year because events are infrequent and there is no benefit in continuing it. Other reports say that when we follow patients out to two or three or even five years， we see some very late stent thrombotic events. When we are in that position in clinical medicine， we are in a state of what I would call clinical equipoise; we don’t really know the answer so we need a clinical trial. Fortunately， there is one ongoing right now. It is the DAPT Study， looking at a very large number of patients who have received a stent and are getting dual anti-platelet therapy. At the end of one year， they are randomized to continue their dual anti-platelet therapy or having it stopped. That is the kind of study that we need to have in order to make a final decision about how long we really need to continue dual anti-platelet therapy. I think it is premature myself， to say give it for less than a year right now based on the evidence we have got. I can’t really say how much longer after one year you should need to give it so I am really looking forward to the results of the DAPT Study.

    Antman教授: 当我们给一个冠脉疾病患者植入支架时，我们给予他们双重抗血小板治疗。如果是金属裸支架，我们维持双重抗血小板治疗几个月。目前，对于接受药物洗脱支架的患者，我们尝试维持双重抗血小板治疗在一年以上，因为我们非常关注晚期支架内血栓形成的可能性。我们得到了两个不同观点的报告。我们看到一些报告告诉我们我们不需要给予双重抗血小板治疗超过一年，事实上，可能不需要维持一整年，因为事件发生不常见，而且继续维持该治疗没有获益。另一些报告说当我们维持2-3年甚至5年后，我们看到一些极晚期的血栓形成事件。当我们在临床实践中处于那个位置时，我们就处于我成为临床平衡的状态；我们并不知道答案所以我们需要临床试验。幸运的是，目前已经有一个试验正在进行，这就是DAPT研究，该研究观察了一个庞大的接受支架治疗及正在接受双重抗血小板治疗的患者群。第一年结束的时候，患者被随机分为继续双重抗血小板治疗组和停止抗凝治疗组。这就是我们需要的这种研究，目的是最终决定我们真正需要持续双重抗血小板治疗多长时间。我个人认为基于我们目前得到的证据而说持续时间为一年之内这种说法仍不成熟。我真的不能说一年后你需要继续给予该治疗多长时间，因此我非常期待DAPT的研究结果。