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November 22, 1995

Costs of Oral Anticoagulation Treatment After Myocardial Infarction-Reply

Author Affiliations

ASPECT Coordinating Centre Rotterdam, the Netherlands

JAMA. 1995;274(20):1589. doi:10.1001/jama.1995.03530200024030

In Reply.  —In their comment on our cost-effectiveness analysis of the ASPECT trial, Drs Bussey and Chiquette empha size the importance of good quality control of oral anticoagulant treatment. The cited 1% anticoagulation-related major bleeding rate of the ASPECT trial is based on the intentionto-treat analysis. A more appropriate assessment of the risk of bleeding involves the per protocol analysis, showing an incidence of approximately 1.5% per year.1 This rate closely resembles the reported bleeding incidence of 1.6% per year when anticoagulation monitoring was performed through the mentioned anticoagulation clinics in the United States. Reports on higher incidence rates of anticoagulation-related bleeding in the United States may have resulted from the use of less sensitive thromboplastins in the past, leading to the prescription of higher doses of anticoagulant drugs.2 The reported bleeding incidence of 4% per year after closure of the anticoagulation clinic, still providing an economic benefit

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