《国际循环》：华法林对降低卒中风险是有效的，但其使用颇为麻烦且常常难以控制。您如何看待华法林的前景？

　　<International Circulation> :Warfarin is effective in reducing stroke risk but is burdensome to patients and is often difficult to control. What is the future of warfarin?

　　Dr Weitz: 我认为，华法林正在逐渐淡出。我们现在有固定的给药剂量、产生一致且可预测的抗凝反应且无需常规监测的新口服抗凝药物。我们从RELY试验中看到，在心房颤动患者中，这种药物，即达比加群酯以150 mg每天2次给药时，对卒中的预防优于华法林。就在昨天，我们从ROCKET心房颤动试验看到，在极高危的心房颤动患者中，利伐沙班对卒中的预防上若不优于华法林，至少也与华法林一样有效。我们现在有更易给药的替代药物。我认为，在未来5年，我们将会看到华法林逐步淘汰，被这些新口服抗凝药物所取代。

　　Dr Weitz:I think warfarin is on its way out. We now have new oral anticoagulants that can be given in fixed doses， produce a consistent and predictable anticoagulant response and don’t require routine coagulation monitoring. In the RELY trial， one such agent， dabigatran etexilate， when given at the 150mg twice daily dose， was superior to warfarin for stroke prevention in patients with atrial fibrillation. Just yesterday， we saw the results of the ROCKET atrial fibrillation trial.  Rivaroxaban also is at least as good if not better than warfarin for stroke prevention in very high risk patients with atrial fibrillation. We now have alternatives to warfarin that are easier to give. Over the next five years， I think we are going to see a gradual phasing out of warfarin and replacement with these new oral anticoagulants.  

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