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—Drs Bussey and Chiquette point out an additional problem in taking cost-benefit data obtained from one health care system and attempting to apply it directly in another. They indicate that major bleeding in routine clinical practice in the United States is likely to be much more common than is the experience in special thrombosis centers in the Netherlands and that the costs associated with major bleeding episodes would be higher. If the frequency of bleeding were in the 10% range, as has been observed in some early reports,1,2 potential cost savings from anticoagulation compared with no antithrombotic therapy could be lost.In the absence of a good trial comparing a structured system of anticoagulant monitoring to routine clinical practice, there is uncertainty about whether the risk of major hemorrhage may be reduced and costs decreased among patients receiving anticoagulant therapy. Even assuming that the achievement of lower
Cairns JA, Markham BA. Costs of Oral Anticoagulation Treatment After Myocardial Infarction-Reply. JAMA. 1995;274(20):1589. doi:10.1001/jama.1995.03530200024031