Why the study?
Do oral anticoagulants provide a cost-effective benefit compared to aspirin or placebo in survivors of acute myocardial infarction?
Do oral anticoagulants provide a cost-effective benefit compared to aspirin or placebo in survivors of acute myocardial infarction?
Oral anticoagulation after acute myocardial infarction may provide a win-win scenario of improved clinical efficacy and reduced healthcare costs.
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.¹An overview in 1970²suggested 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,³Warfarin Re-infarct Study,⁴and the Anticoagulants in the Secondary Prevention of Events in Coronary Thrombosis (ASPECT)⁵trials have all shown statistically significant reductions of clinically important vascular outcomes by anticoagulant treatment compared with placebo. See also p 925. In this issue ofJAMA, van Bergen et al⁶report 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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John A. Cairns (1995) studied this question.
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