International Circulation: There were number of comparative studies focus on the double-dose of prasugrel and clopidogrel in this conference， what’s the clinical significance of those compare between   ordinary dose of prasugrel and high-dose clopidogrel?
　　国际循环：本次大会报道了多项普拉格雷与双倍剂量氯吡格雷的比较研究，请问将普拉格雷普通剂量与大剂量氯吡格雷进行比较的临床意义何在？
　　Dr Sigmund Silbur: There is a big difference between prasugrel and clopidogrel. This in terms of the response of the patient can be unpredictable. There is a degree of luck involved in which the patient will have a good response to clopidogrel or they could have a poorer diminished response. On the other hand almost all patients respond well to prasugrel and for this giving clopidogrel is like a guessing game， whilst prasugrel is much more reliable. This could be attributed to a genetic disposition and you could run some tests to determine whether you would be a good responder or not. In patients with acute coronary syndrome we have almost stopped giving clopidogrel even at high double doses because the current OASIS Trial was a negative trial， whereby the primary endpoint was not reached. This where they compared double dose clopidogrel with the normal dose， the protocol has been subject to questioning， because the comparative group was given only a 300mg loading dose. However， all the patients in the study should have been given 600mg loading dose and then be given the double dose or the regular dose. To cut a long story short I would much rather be on the safe side giving prasugrel to my patients rather than entering a game of chance with clopidogrel. The only reason I do not give prasugrel is due to the contraindications of the patient such as TIA or whether the patient has suffered a stroke， in these brain circumstances I would prefer clopidogrel over prasugrel.
　　Sigmund Silber医生：普拉格雷和氯吡格雷之间有着很大的差别。就患者的反应来说是不可预知的。患者对氯吡格雷的反应好或是差有很大的运气成分在里面。在另一方面，几乎所有的患者对普拉格雷的反应都很好，因此使用氯吡格雷就像一个猜谜游戏，而普拉格雷则更为可靠。这种情况可以归因为遗传倾向，你可以接受一些测试来确定自己是否对其反应良好。对于急性冠脉综合征的患者我们几乎不再选用氯吡格雷，即使是双倍的高剂量，这是因为当前的OASIS试验为阴性，即没有达到试验的主要观察终点。该试验中，他们将双倍剂量的氯吡格雷和正常剂量的氯吡格雷进行了对比，该试验一直饱受质疑，这是因为对照组只接受了300毫克的负荷剂量，而该试验的所有患者都应该接受600毫克的负荷剂量，然后再接受双倍剂量或者正常剂量。长话短说，我宁愿慎重起见让我的患者们采用普拉格雷，而不是进行“博弈游戏”选择氯吡格雷。除非患者有禁忌证不能接受普拉格雷，比如患者存在短暂性脑缺血发作或是患者发生了卒中，在这些脑部疾患的情况下，我会倾向选择氯吡格雷而不是普拉格雷。
　　International Circulation: Gene polymorphism influencing the efficacy for prasugrel is a research hotspot. Does this mean that if we want to increase the benefit of patients， routine genetic scanning is necessary?
　　国际循环：基因多态性对于普拉格雷疗效的影响是一个研究热点。这是否意味着若想增加患者的获益，需要常规进行基因学扫描？
　　Dr Sigmund Silbur: This is an interesting question but I think this only refers to patients with stable coronary artery disease. I have already made my statement for patients with ACS， but for these patients with stable coronary artery disease， prasugrel is not approved for stable artery disease because we just do not have enough data. It might make sense to be on the safe side to do a genetic polymorphism test to determine whether or not they are low or high responders to clopidogrel in which case you would give them prasugrel.
　　Sigmund Silber医生：这个问题很有意思，但是我认为这只适用于稳定的冠状动脉疾病患者。
　　我已经就急性冠脉综合征患者发表了自己的看法，但是对于稳定的冠状动脉疾病患者来说，普拉格雷还没有批准应用于此类患者，这是因为我们还没有足够的数据。为了慎重起见做一个基因多肽扫描可能是有意义的，能确定他们对氯吡格雷反应是否良好，在这一情况下则是普拉格雷。