Dr. Collet: The first criteria is the label of the drug. If you are in the labeling， there is no problem. The second criteria is the local constraints because the new drugs are expensive and not available everywhere.

　　Making the assumption that all drugs are available and that there are no money constraints， then the method of choosing drugs will depend on the risk of your patients. If you are off-label and this may happen some of the times， you need to have a careful assessment of the clopidogrel resistance of your patients. You may have very high-risk patients who are diabetics， who are having regular intervention while being on clopidogrel and overweight who would be good candidates for the P2Y₁₂ inhibitors.

　　The main example is peristalsis stent thrombosis. You may have some patients with history of  peristalsis stent thrombosis who present on DAPT with clopidogrel and probably they are good candidates to be switched to the new one because you may face a new stent thrombosis.

　　I think we need to be clear and have simple clinical characteristics， which are related to clopidogrel resistance， which are diabetes， ACS presentation， and the type of lesion you are presented with. It would be very easy to make up your mind on which treatment to choose.

　　《国际循环》：我们都知道双联抗血小板治疗（DAPT）对于PCI术后患者是非常重要的，选择合适的P2Y₁₂受体拮抗剂的标准是什么？

　　Collet博士：第一个标准是药物要有PCI的适应证。如果有适应证，就没有问题。第二个标准是当地的报销限制，因为新药的价格昂贵，并不是很多地方都能报销。

　　假设有药同时没有报销限制，那么药物的选择将取决于患者的风险。如果是超过适应证的使用范围，有时候可能会有这种情况，你就需要详细评价患者的氯吡格雷抵抗情况。你可能接诊了一位像糖尿病患者这样的极高危患者，患者接受了常规的介入治疗，服用了氯吡格雷，该患者是超重的，可能很适合应用P2Y₁₂抑制剂。

　　举例说明，支架血栓。有些患者可能有支架血栓形成史，就诊时已经应用了包括氯吡格雷在内的双联抗血小板治疗，这些患者因为可能会面临新的支架血栓形成的问题，比较合适换用其他抗血小板药物。

　　我认为我们应当明确一些简单的临床特点与氯吡格雷抵抗相关，包括糖尿病、急性冠状动脉综合征的表现和病变类型，然后决定选择哪种治疗是非常容易的。