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March 22, 1995

Economics and Efficacy in Choosing Oral Anticoagulants or Aspirin After Myocardial Infarction

Author Affiliations

From the Departments of Medicine (Dr Cairns), Clinical Epidemiology and Biostatistics (Dr Cairns and Ms Markham), and the Centre for Health Economics and Policy Analysis (Ms Markham), McMaster University, Hamilton, Ontario.

JAMA. 1995;273(12):965-967. doi:10.1001/jama.1995.03520360079044

Long-term antithrombotic therapy with oral anticoagulants or antiplatelet agents for survivors of acute myocardial infarction (AMI) is widely prescribed and has been evaluated in many clinical trials.1 An overview in 19702 suggested a modest benefit of anticoagulation therapy, but—although oral anticoagulants have been widely used in some European countries—their use in North America is limited. More recently, the Sixty Plus,3 Warfarin Re-infarct Study,4 and the Anticoagulants in the Secondary Prevention of Events in Coronary Thrombosis (ASPECT)5 trials have all shown statistically significant reductions of clinically important vascular outcomes by anticoagulant treatment compared with placebo.

See also p 925.

In this issue of JAMA, van Bergen et al6 report on an economic analysis of anticoagulant treatment in the Netherlands that exemplifies the rather unusual win-win situation of increased efficacy and reduced cost. The ASPECT study randomized 3404 patients within 6 weeks of their AMIs to

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