<International Circulation>: In order to achieve better stroke prevention results， we need to make an objective appraisal of the role and usage of the good old vitamin K antagonist warfarin versus the low-molecular-weight-heparins such as fondaparinux. What has been your point of view and the consensus at this meeting?

    Prof. Verheugt: Unlike the acute coronary syndrome scenario where the platelets play the significant role in the high shear stress situation of arterial flow， the low flow scenario of atrial fibrillation puts high demand on the coagulation cascade and it was necessary to develop better drugs than warfarin in this setting. The requirement was not specifically for better efficacy but for safety and ease of handling. This is where the new thrombin blockers and oral factor Xa blockers come into play and are currently under evaluation and the first signs look rather promising. There has been one big and some smaller studies on subcutaneous therapies for atrial fibrillation but it is not very pleasant for the patient to be injecting themselves daily. There has been one study on once a week super-low-molecular-weight-heparin， a pentasaccharide， and that drug was effective but was associated with significant bleeding. The problem of these newer drugs is that they don’t have an antidote. We know if a patient is on warfarin and starts to bleed， we know exactly the strategy to block the anticoagulation and we do not have that choice with the newer drugs. But oral anticoagulants is the area of advancement in the atrial fibrillation stroke prevention setting.