<International Circulation>:  So most of these patients， even though they get re-evaluated， probably do experience a decrease in their risk of bleeding or risk of thrombosis?  Also， how do you re-evaluate?
   《国际循环》：因此大多数患者，即使他们被重新评估，很可能他们的出血或血栓形成风险会降低？还有，您如何进行再评估？

    Prof. Weitz: That is probably correct.  It is necessary to give them the information that we have and balance the risks versus benefits.  If they stay on anticoagulants they have the inconvenience of anticoagulation and the risk of bleeding.  We can assess their risk of bleeding because we can know if they have bled so far.  We can also know that if they stop anticoagulant therapy they have a 10% risk of recurrence in the first year and 30% by five years.  One of the researchers in our group is evaluating is a strategy， recruitment has begun with about 50 more patients to go， to take such patients and give them at least three months but no longer than 6 months of anticoagulant therapy， then we do a D-dimer test while they are still on warfarin.  If that test is still negative， which it is in about 95% of patients， we stop the warfarin for one month and repeat the D-dimer.  If the D-dimer has reverted back to being positive we recommend that they go back to taking warfarin.  If the D-dimer is negative we continue to follow them and monitor their risk of recurrence.  The purpose of this research is to see if you can use a D-dimer based strategy to identify patient that are at a lower risk of recurrence.  It determines exactly what is that risk.  Because we will have blood samples from these patients we will be able to look at different D-dimer assays， different cut-off levels and really determine the risk of recurrence if the D-dimer level is negative at one month.  We’ll be able to know if it is really safe to withhold anticoagulants after a month.  Next month we will hear about the study done in Italy that took patients off warfarin and put on aspirin and then looked at the risk of recurrence.  Some experts will treat these patients for 6 months and then stop， then only if the patient has another event will they treat with long-term anticoagulant therapy.  Otherwise you are committing all these patients to long-term elevated risk of bleeding.
    Weitz教授:这是正确的。有必要给他们我们已知的信息以及风险获益比。如果他们继续抗凝，他们有抗凝的困难和出血的风险。我们可以评估他们的出血风险因为我们能知道到目前为止他们是否有出血。我们也可以了解他们是否已停止了抗凝治疗。他们第一年有10%的复发率，第5年有30%的复发率。我们研究组的一个研究人员正在进行此项评估。我们入选了50多名患者，给他们至少3个月，最长不超过6个月的抗凝治疗，然后当他们正在服用华法林时进行D二聚体检测。如果 95%的患者检测结果仍为阴性，我们会停用华法林一个月仍后再进行检测。如果D二聚体检测结果为阳性，我们推荐他们再继续服用华法林。如果D二聚体检测结果为阴性，我们继续随访 和监测他们的复发率。这精确地决定了什么是危险因素。因为我们取得这些患者的血样标本，能观察不同的D二聚体检测结果，不同的阶段水平以及如果一个月时D二聚体的检测结果为阴性，即真正明确复发的风险。我们将能知道一个月后停用抗凝剂是否真正安全。下个月我们将听取在意大利所做试验的回报，该试验是用阿司匹林取代了华法林以观察复发风险。一些将治疗这些患者6个月然后停止，另一部分患者将接受长期抗凝治疗除非他们发生另一个事件。否则你将使这些患者长期处于出血的风险。

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