<International Circulation>: In the clinic we have some patients at risk for recurrence of venous thromboembolism. What is your opinion of long-term anticoagulant therapy for these patients?
《国际循环》：在临床中，我们会有一些有静脉血栓栓塞复发风险的患者。对这些患者的长期抗凝治疗您的观点是什么？
Prof. Perrier: This would be for patients with acute deep vein thrombosis or acute pulmonary embolism. There is a very modern and still ongoing debate whether patients with venous thromboembolism should be treated long term， that is longer than the initial 3 to 6 months of treatment. We know that the average patient who has had a clear provoking factor; orthopedic surgery， for instance， can be treated for only three months and has a low risk of recurrence of about 1% per year. Those patients can be treated for three months and then anticoagulation can be stopped. The problem patients are those with unprovoked DVT or PE because they have an approximately 8% per year recurrence rate after stopping anticoagulants. Of course， if anticoagulants were completely safe， then all those patients would be treated long term. However， since we have an approximately 2% risk of major bleeding with anti-vitamin K agents， we would like to have a better risk stratification system. There is a clinical prediction rule that has been developed by the REVERSE study group [Add the reference?]that allows the identification of women with a low risk of recurrence who， although they had unprovoked DVT or PE， could be treated for only three months. This is being validated prospectively in the REVERSE II study. D-dimer has been disappointing because even in patients who have a normal D-dimer after stopping anticoagulants instead of a persistently elevated D-dimer there is still approximately a 4~6 % yearly recurrence rate， which is too much to say that they are low risk and stop using anticoagulants. Therefore， we are all looking for more risk stratification instruments to help make clinical decisions for those patients.
Perrier教授：这是对那些有急性深静脉血栓形成或急性肺动脉栓塞的患者。有一个非常现代但仍在进行的争论，即静脉血栓栓塞患者是否应该接受长期治疗，也就是说长于初始3～6个月的治疗。我们知道，有明确触发因素（如骨科手术）的一般患者可仅接受3个月的治疗，且复发风险低，约1%/年。这些患者可治疗3个月，继而可停用抗凝治疗。问题是那些不明原因DVT或PE的患者，因为在停用抗凝后他们有约8%/年的复发率。当然，如果抗凝绝对安全，那么所有这些患者均进行长期治疗。然而，由于我们用维生素K拮抗剂有约2%的主要出血风险，因此我们想要有一个更好的危险分层系统。REVERSE研究组已经制定出一个临床预测规则，使得我们可以识别出那些尽管曾有不明原因DVT或PE但复发风险低的女性，对其治疗仅3个月。这在REVERSE II研究中得到前瞻性验证。D-二聚体令人失望，因为在停用抗凝药物后，即使在D-二聚体正常的患者中，而不是D-二聚体持续升高者，每年仍有约4%～6%的复发率，这一数字太高，因此不能说他们是低危患者且可停用抗凝药物。所以，我们都在寻找更多的危险分层方法来帮助对这些患者作出临床决策。
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