<International Circulation>:  With all the anti-thrombotic drugs now it seems that there may be different indications for each drug and a very diverse set of drugs in different places.  For most clinicians is this multitude of choices and interactions to consider confusing?

   《国际循环》：现在看来，对于所有的抗血栓药物，每种药物的适应症可能都不同，在不同的情况有不同的药物联合。对于大多数医生来说，太多的选择和药物联合是会让人很困惑呢？
 
    Prof. Mahaffey:  This is a critically important issue and touches on a variety of different things.  It touches on how we as a research community are interpreting and sharing data within the research community itself， but also， when you have promising therapies that get to market， with physicians so they can integrate it into clinical practice.  Many physicians don’t have the time to keep up with research.   I get time to do research and don’t see patients all day every day.  For clinicians who do see patients all the time we as a research community need to synthesize the data better and interpret it better in order to figure out how to apply it in clinical practice.  This is just part of education in general.  The second thing is that we do need to study drugs across multiple indications.  This is happening now more.  Rivaroxaban， for instance， has been studied in surgical patients， in DVT and PT treatment， for atrial fibrillation， and we have just seen data from an ACS population and every one of these studies used a different dose.  If you have one drug across all the indications does make it easier because you get to learn the safety profile， dosing profile and drug/drug interactions that go with it.  Although there are few， if all a physician would have to do is remember one drug and a couple of different dosages， it would be simple.  There are a lot of drugs out there like dabigatran for atrial fibrillation and rivaroxiban.  How can an average physician compare them when we don’t have a head-to-head comparison to definitively tell you which one is better than the other?  It really is going to be an exciting time over the next few years. 

    Mahaffey教授：这是一个极为重要的问题，而且涉及到各种不同的方面。这不仅涉及到我们作为一个研究团体如何在研究团体内解读和分享数据，而且在该药物进入市场时，如何向医生解读这些数据，以便使他们能够融入临床实践。许多医生没有时间跟上最新的研究。我有时间做研究，并没有每天都一整天看到病人。为了那些能看到患者的临床医师，我们作为一个研究社会需要更好地综合和解释数据，以找出如何更好在临床实践中应用的方法。这是普及教育的一部分。第二件事是，我们确实需要研究跨多个适应症的药物。现在这样的药物更多了，例如，利伐沙班，已在手术病人、DVT和PT治疗、房颤中进行研究，我们刚才看到来自ACS人群的数据和每一个这些研究都使用不同的剂量。如果有一种药物适合所有适应症，使用更容易，因为你已经熟悉它的安全性，剂量和药物/药物的相互作用。虽然是少数，如果医生只需要记住一种药物和几种不同的剂量，那就简单的多。有很多药物，如治疗房颤的达比加群和利伐沙班。如果我们没有直接比较两种药物，并明确告诉他们哪个疗效更优，一般的医生怎样可能判定他们的优劣？未来几年的研究让人期待。