Economics and efficacy in choosing oral anticoagulants or aspirin after myocardial infarction
Article Abstract:
Research is needed to evaluate the cost-effectiveness of aspirin compared with oral anticoagulants in preventing vascular complications in heart attack survivors. In 1995, Dutch investigators revealed that oral anticoagulants cost-effectively reduce vascular complications in heart attack survivors compared to placebos. The economic benefits of oral anticoagulants cited by the Dutch do not apply in the US. Oral anticoagulants must be compared with aspirin which also prevents vascular complications, saves money, and is more commonly used in the US. In addition, the costs of medical procedures, hospitalization, and patient follow-up differ between countries and the ratio of American to Dutch costs per intervention fluctuates. Two research studies underway in 1995 are comparing warfarin to aspirin in heart attack survivors. Until these investigations are completed, most heart attack survivors should receive 160 to 325 milligrams of aspirin per day.
Publication Name: JAMA, The Journal of the American Medical Association
Subject: Health
ISSN: 0098-7484
Year: 1995
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Costs and effects of long-term oral anticoagulant treatment after myocardial infarction
Article Abstract:
Long-term anticoagulant therapy appears to cost-effectively prevent cardiovascular complications in heart attack survivors. Researchers followed 3,404 heart attack survivors, approximately half of whom took oral anticoagulants after hospital discharge while the other half took placebos. After an average period of 37 months, placebo-treated patients as a group had spent 3,747 more days in the hospital than anticoagulant-treated patients. Most of the disparity in hospitalization rates was due to more admissions for subsequent heart attacks and unstable chest pain in placebo-treated patients. Anticoagulant-treated patients had 220 fewer admissions for thromboembolic complications and 43 more admissions for bleeding complications. More placebo-treated patients had angiographies and angioplasties than anticoagulant-treated patients. The average cost of medical care was $6,029 per anticoagulant-treated patient and $6,543 per placebo-treated patient.
Publication Name: JAMA, The Journal of the American Medical Association
Subject: Health
ISSN: 0098-7484
Year: 1995
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Increased incidence of silent ischemia after acute myocardial infarction
Article Abstract:
Many patients who are treated with thrombolytic drugs, or drugs that break up blood clots, may develop silent myocardial ischemia after a heart attack. Individuals with silent myocardial ischemia have inadequate circulation to the heart, but they do not experience symptoms such as chest pain. Among 55 patients who underwent angioplasty, 25 had chest pain with no earlier history of a heart attack and 30 had been treated intravenously with thrombolytic drugs after a heart attack two days earlier. Thirty-six percent of the patients with chest pain had silent myocardial ischemia during angioplasty, compared with 70% of the patients who had been treated with thrombolytic drugs for a heart attack. Patients who have suffered a heart attack may not experience symptoms during myocardial ischemia because of injury to the nerves of the heart.
Publication Name: JAMA, The Journal of the American Medical Association
Subject: Health
ISSN: 0098-7484
Year: 1992
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