IC: Could you speak briefly to the prevention of AF?
　　IC:请您简要介绍一下房颤的预防？
　　Dr. Johnston: In terms of prevention， we do not have many direct approaches to reducing the risk of AF. AF occurs more commonly in people with heart disease. All the risk factors for HD become relevant to the development of AF. Alcohol and hyperthyroidism are two other important cause of AF. Treating hyperthyroidism and alcohol use are ways of treating AF. Drug therapies are no so effective. There are some available to those who are intermittently in AF， but not terribly effective. Although by controlling heart disease risk we can control the risk of AF， we will always have cases of AF out there.
　　Dr. Johnston:谈及房颤的预防，目前尚缺乏减少房颤风险的直接方法。房颤通常发生于心脏病患者，心脏病的所有危险因素均可促进房颤进展。饮酒及甲状腺机能亢进（甲亢）是另2个导致房颤发生的重要原因。因此，积极治疗甲亢及戒酒是治疗房颤的重要方法。药物疗法对于房颤的效果并不明显，虽然存在一些针对阵发性房颤的有效疗法，但效果不佳。通过控制心脏病的危险因素可降低房颤的发生风险，但仍不断有房颤患者出现。
　　IC: When it comes to methods to preventing stroke when you have patients with AF?
　　IC:对于房颤患者，何时采取措施以预防卒中的发生？
　　Dr. Johnston: Beyond anticoagulants， antiplatelet agents can be effective. Aspirin alone in low-risk patients， and even in high-risk is one of choose drugs for combination therapy.
　　Dr. Johnston: 预防卒中不仅仅依靠抗凝药物，抗血小板药物同样有效。低风险患者可单用阿司匹林，高风险也可作为联合用药的选择。
　　Dr. Johnston: For patients at low-risk of stroke， aspirin is an alternative to anticoagulation. For patients at higher risk， aspirin and clopidogrel is also another option. For patients at high-risk， AC is the treatment of choice.
　　Dr. Johnston:对于低卒中风险的患者，可选择阿司匹林进行抗凝治疗。高分险患者，则可选用阿司匹林联合氯吡格雷治疗。
　　IC: You gave at talk the ISC on how to select patients with AF for stroke prevention. What are some ways to stratify these patients?
　　IC:在ISC（国际卒中大会）上，您曾提到如何选择房颤患者进行卒中预防，那么如何对这一类患者进行分类？
　　Dr. J: At the ISC， I focused on， after having a stroke， how do we determine who should be anti-coagulated. The key there is that pretty much everybody who has had an ischemic stroke is at extremely high risk of having another one， especially those with AF. That crew， universally， unless there is some strong contraindication， should be treated with AC. The problem comes where there is group of patients with paroxysmal AF. Some recent studies， including ones that we have， have shown that that percentage is higher than we have previously thought， and could be as high as 5% of all comers. Those who are assumed not to have AF when they come in are later discovered to have AF within a few weeks. Presumable， in those patients， the AF was the cause of the stroke. That risk is even higher in whom you initially could not determine the cause of the stroke. Again， suggesting that AF was ultimately the cause. One of the things I was trying to stress at the conference was that we need to monitor these patients and should be monitoring all those patients in whom we have not identified a cause of stroke. We need to monitor them with long term cardiac monitoring， 14-21 of outpatient cardiac monitoring. In doing that， we will find cases of AF and those cases will need to be treated.
　　Dr. J:在ISC会议上，我主要谈到了如何判断卒中后需要接受抗凝治疗的患者。问题是几乎所有存在缺血性卒中病史的患者均有极高的再发风险，房颤患者尤甚。这类患者，除非存在绝对禁忌，否则均应接受阿司匹林和氯吡格雷。那么阵发性房颤患者呢？近来的研究显示，阵发性房颤的发生率比我们之前预想的要高，几乎占所有研究对象的5%。那些入选时被认为无房颤的患者，在研究开始后的几周内被发现存在房颤。可以预想，这些患者中，房颤是导致卒中的主要原因。这些最初未被检测出卒中病因的患者，其风险甚至更高，而且房颤是诱发卒中的最终原因。我在会议上一直强调，我们需要对患者进行监测，并应对所有未明确卒中病因的患者进行监测。需要长时程（14-21小时）的门诊心脏监测，通过这一方法，我们能筛查出房颤患者并对其进行治疗。

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