<International Circulation>: Yes I remember at the presentation you said it would not change the recommendations. Can you give us a summary at the current stage with the clinical trials with new antiplatelet drugs. What is your recommendations to choose the drugs in ACS patients?
Prof.  De Caterina: The recommendations state that in  patients with acute coronary syndrome， and in patients with non-ST elevation acute coronary syndromes， you may in all cases use ticagrelor.  Ticagrelor has been demonstrated as effective and reasonably safe in both invasive and medically treated patients. By the way， the medically treatment population of the PLATO study was not a small， with over 4，000 patients.  In those 4，000 patients， it was possible to demonstrate efficacy of a more intense platelet inhibition， in terms of reduction of myocardial infarction， stroke， and cardiovascular death， but also with the single endpoint of death. Mortality was significantly reduced in that population.  For prasugrel， based on the data from TRITON and TRILOGY， we have to remain with the indications of TRITON. For people who are going to be invasively treated， and if they are also clopidogrel naive - because this is another inclusion criteria of TRITON， one can use prasugrel and here this is better than using clopidogrel.
《国际循环》：是的我记得您在此次的演讲中说道试验的结果并不会改变指南推荐。您能给我们总结一下目前新的抗血小板药物临床试验的现状吗？您认为ACS患者应该选择什么样的药物？
De Caterina教授：推荐认为对于急性冠脉综合征的患者，我们指的是非ST段抬高型急性冠脉综合征的患者，所有的都应该使用替卡格雷。在侵入性治疗患者和药物治疗患者中替卡格雷已经显示出有效和足够的安全，而且需要说明的是，使用药物治疗的患者群并不是少数，超过4000患者。并且在这4000患者中能显示出以心肌梗死、中风、心血管事件以及单一终点死亡的减少为标准的更强的血小板抑制有效性，因此死亡率在这一人群中普遍降低。对于普拉格雷，基于TRITON的数据和最近TRILOGY的数据，我们必须遵循TRITON的建议，因此当患者准备进行侵入性治疗时，如果他们正在使用氯吡格雷，由于这是一另项包括的标准，根据这一建议，这些患者需要使用普拉格雷。
<International Circulation>: I remember it is also for diabetic patients， in the TRITON trial is seems that prasugrel is better for diabetic patients.
Prof.  De Caterina: It is true that the diabetic population may derive a special advantage. The PLATO population of diabetic patients， however， had a largely overlapping pattern. The impression is the separation of the efficacy and safety curves for prasugrel was better in diabetic patients than you got in the PLATO sub-study in some diabetic patients. However， if you look carefully into those data， the outcomes are relatively similar. In diabetic patients， you still have both options.
《国际循环》：我记得这也使用于糖尿病患者，在TRITON试验中，似乎普拉格雷更适用于糖尿病患者。
De Caterina教授：这是事实，特别是对于糖尿病人群，普拉格雷可能得到特殊的获益，但是我需要说明的是糖尿病患者中的高原人群有更大的重叠现象，因此我们的印象是普拉格雷有效性和安全性的分离在糖尿病患者比高原研中的糖尿病患者更显著，但是我要说的是如果你仔细分析这些结果就会发现结果非常相似，所以在糖尿病患者中你仍然有两种选择。
<International Circulation>: What do you think is the take home message of the TRILOGY trial?
Prof.  De Caterina: From the TRILOGY the take home  message is that changing clopidogrel for prasugrel  in medically treated non-ST elevated， acute coronary syndrome therapy is not warranted.
《国际循环》：您认为TRILOGY试验所得到的最终信息是什么？
De Caterina教授：TRILOGY试验所得到的最终信息是对于接受药物治疗的非ST段抬高型急性冠脉综合征患者，并没有证实普拉格雷优于氯吡格雷。

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