<International Circulation>: There is a growing awareness of the issue of venous thromboembolism and clinicians would like to know how to use anticoagulant therapy properly. How can we use anticoagulant therapy to prevent venous thrombolism?

《国际循环》：静脉血栓栓塞问题引起越来越多的关注，临床医生想要知道如何正确应用抗凝治疗，我们怎样应用抗凝治疗来预防静脉血栓？

    Prof. Perrier: There is a huge amount of literature on this subject and there are two categories of patients that you must distinguish. The first category of patients is surgical patients. The guidelines for surgical patients are extremely straightforward. Of course， one of the references in the field remains the guidelines of the American College of Chest Physicians (ACCP)， which were updated in 2008. There is a vast array of techniques and anticoagulants that can be used and patients are mostly correctly identified even though there is some evidence that there could be some under-prescription even in surgical patients. However， the most important problem right now is probably medical patients because there is a vast amount of evidence that they are under-treated by prophylactic anticoagulants. Also， we lack a very efficient， simple， and validated clinical score that allows us to classify patients in adequate risk categories and so that is a remaining problem. Certainly， older patients， obese patients， immobilized patients， infected patients， patients with cardio-respiratory insufficiency， and indisputably patients with cancer， should have thromboprophylaxis while in the hospital.

    Perrier教授：有关这一问题有大量的文献，有两类患者必须区分。第一类患者是手术患者。手术患者的指南非常简单。当然，该领域的参考资料之一仍然是美国胸科医师学会（ACCP）指南，该指南于2008年更新。可用的技术和抗凝药物数量巨大，即使有些证据表明可能有一些患者，甚至是手术患者，未得到治疗，但大部分患者得到正确识别。然而，目前最重要的问题很可能是内科患者，因为有大量证据显示他们未得到充分的预防性抗凝治疗。另外，我们缺乏一种可使我们将患者分为适当风险类别的非常有效、简便且经过验证的临床评分，因此这仍是一个遗留问题。当然，高龄患者、肥胖患者、制动的患者、感染患者、心肺功能不全的患者以及无可争议地癌症患者均应该在住院时进行血栓预防。

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