International Circulation: In less well-financed hospitals that may not have access to second generation stents， would you still suggest the same level of caution?
Dr. Mehran: Absolutely. Everyone has access to second generation stents. In fact， first generation stents are also extinct in the US. In China， there has to be tremendous oversight for the first generation of drug-eluting stents through the physician guidance. It is important think about that as well.
《国际循环》：很多经济不发达地区还没有第二代支架，您的建议是？
Mehran教授：医生对置入第一代支架的患者，应非常非常注意，应更为密切地指导患者。
International Circulation: The PARIS trial may give confidence to doctors who are considering taking their patients off of DAPT. Do you have any personal tips for these doctors?
Dr. Mehran: When it comes to first generation drug-eluting stents， I would not consider discontinuing therapy for at least the first six months. It should be an important circumstance. With the second generation， we have good enough data to show that beyond three months you can interrupt them under your guidance to watch them through a non-cardiac or surgical procedure when interrupting their DAPT. There are certain cases where you know that the bleeding complications are high， like in the elderly， in females， in small sized peatients. You do not want them to be taking these even with minor bleeding episodes. You are concerned they may not be compliant. It is best to think about those patients and consider discontinuing therapy in these patients if everything else equal. With that being said， this puts an underling importance on a randomized study. Before that， these are just observational， hypothesis-generating data. I do not think we can give any clear recommendations. We can only suggest that physicians are extremely important in the decision whether or not to stop duel antiplatelet therapy.
《国际循环》：PARIS研究可能带给医生信心来停用DAPT。您有什么建议给这些医生？
Mehran教授：我认为第一代DES至少要使用6个月的DAPT，这一点很重要。对第二代DES而言，我们有足够好的证据说明3个月后，如果需要外科手术，在医生的指导下，可以中断DAPT。有些患者出血风险很高，如老年人、女性或体重低的患者。医生可能不希望这些患者长期服用DAPT，甚至在一些小的出血事件时。这些患者还可能依从性差。对这些患者，如果其他情况没有异常，最好考虑停药。尽管我这样说了，但重要的是进行一项随机试验，在此之前，所有的数据都是观察性的、产生假设的。我不认为能够给予确切的推荐，我们只是建议医生在决定是否继续DAPT上的重要作用。
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