To the Editor.
—The cost analysis from the Anticoagulants in the Secondary Prevention of Events in Coronary Thrombosis (ASPECT) group1 and the accompanying Editorial on the US perspective by Dr Cairns and Ms Markham2 overlook one very important point. Neither article considered that the incidence of anticoagulation-related major bleeding appears to be much higher in routine clinical practice in the United States than in the Netherlands.The anticoagulation-related major bleeding rate in the ASPECT trial is approximately 1% per year (major bleeding rate in the anticoagulated group minus major bleeding rate in the placebo group). In the Netherlands, this bleeding risk is similar to that seen in routine clinical practice. However, such a low complication rate is probably due to their 30-year experience with a national network of anticoagulation clinics (ie, "thrombosis centers"). No such network exists in the United States where the reported rates of major bleeding
Bussey HI, Chiquette E. Costs of Oral Anticoagulation Treatment After Myocardial Infarction. JAMA. 1995;274(20):1588-1589. doi:10.1001/jama.1995.03530200024029