<International Circulation>: Do you think patient characteristics will have some influence on the duration of therapy?

  《国际循环》：您认为患者的特点将对该治疗的持续时间有一些影响吗？
    Prof Antman:That’s possible. I am sure that the DAPT investigators who I know very well are going to be looking at patient characteristics and I anticipate that they will be doing subgroup analyses. I would say that patients who are diabetic and those who have had STEMI will be the ones that we will worry about the most; especially the diabetic patients and we will need to see an even more prolonged duration of dual anti-platelet therapy.

    Antman教授: 这是可能的。我相信我非常熟悉的DAPT的研究人员会观察病人的特点，并且我预计他们将可能做亚组分析。我会说那些糖尿病患者和STEMT的患者将可能是我们最担心的患者；尤其是糖尿病患者，我们可能需要观察更长的一段双重抗血小板治疗的时间。
    <International Circulation>:  We know from TRITON-TIMI 38 that prasugrel gives more benefit in diabetic patients. Do you have an explanation for that?

  《国际循环》：通过TRITON-TIMI 38我们了解到普拉格雷对糖尿病患者有更大的获益，您能解释一下这种情况吗？
    Prof Antman: I was a principle investigator for the TRITON-TIMI 38 trial and it was a study that compared the powerful P2Y12 inhibitor prasugrel with clopidogrel， both given on top of aspirin， and indeed， the diabetic patients had particular benefit on prasugrel. Why is that the case? We have learned that patients who have diabetes have very active platelets and have a higher degree of platelet aggregation so it makes perfect biological sense that if you gave a drug that was capable of inhibiting platelets more effectively than clopidogrel you would see greater benefit in patients who were already doing a lot of platelet aggregation. So the diabetic subgroup had a particularly striking treatment benefit. 

    prof Antman:我是TRITON-TIMI 38试验的主要研究者之一，该试验是一个比较强效P2Y12抑制剂普拉格雷和氯吡格雷的研究，后两者药物都作用于阿司匹林上游途径，事实上，糖尿病患者从普拉格雷治疗中尤其能获益。为什么如此呢？我们以及了解到糖尿病患者拥有活化的血小板，并且有高水平的血小板凝集，因此如果你给予一种比氯吡格雷能够更有效地抑制血小板的药物，你将会看到这些已经拥有大量血小板凝集的患者有更大的获益，这有完美的生物学意义。因此糖尿病亚组有一个特别突出的治疗获益。
    <International Circulation>:  Our Chinese audience has a particular interest in proton pump inhibitors (PPIs) and anti-platelet agents. What is the best way to combine these two classes of drugs?

   《国际循环》：我们的中国读者对质子泵抑制剂和抗血小板药物尤其有兴趣。这两种药物结合起来的最好方式是什么？
    Prof Antman: Proton pump inhibitors can， in the case of some drugs， theoretically interfere with the ability to generate the active metabolite of clopidogrel. We have had a lot of discussions about that and it looks like pantoprazole is probably a safer drug than omeprazole but it is not a very strong piece of evidence. But I think the risk of using the drugs in combination is not that great.
 

    Antman教授: 在某些药物，质子泵抑制剂理论上可能影响氯吡格雷活性代谢物的产生能力。我们已经就这个问题进行过很多讨论，跟奥美拉唑相比，似乎泮托拉唑很可能是一个更安全的药物，但是，证据仍不够强。但是我认为结合使用这两种药物风险不是很大。

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