Simpler blood thinning medication effective for preventing blood clots ...( temic embolism. Low rates of thromboemb...),Health

temic embolism. Low rates of thromboembolism and bleeding occurred when ximelagatran was given in a fixed dose without anticoagulation monitoring. Further investigation is needed to clarify the risk of serious hepatic reactions and identify predictive features to select appropriate patients for treatment with ximelagatran. In the balance are a large number of potentially preventable fatal or disabling strokes that accumulate as a consequence of the limitations and underutilization of warfarin," the authors write.
(JAMA. 2005;293:690-698. Available post-embargo at JAMA.com)

Editor's Note: This study was funded by Astra-Zeneca. For financial disclosure information, please see the JAMA article.

Ximelagatran Not Likely to be Cost-Effective in Preventing Stroke in Most Patients With Atrial Fibrillation

In a related article in this week's JAMA, Cara L. O'Brien, M.D., and Brian F. Gage, M.D., M.Sc., of the Washington University School of Medicine, St. Louis, compared the projected quality-adjusted survival and costs of ximelagatran, warfarin, and aspirin in patients with chronic atrial fibrillation.

With a more favorable pharmacokinetic profile, equal efficacy in stroke prevention, and probable lower risk of bleeding, ximelagatran may increase quality-adjusted survival compared with warfarin, according to background information in the article. However, it is unclear whether this improvement justifies the additional cost and offsets rare liver toxicity.

The study included the analysis of a hypothetical group of 70-year-old patients with chronic atrial fibrillation, varying risk of stroke, and no contraindications to anticoagulation.

"We found that switching therapy for a patient with atrial fibrillation and low bleeding risk from warfarin to ximelagatran would increase survival modestly (0.12 quality-adjusted life-year [QALY]) at a substantial cost. In the base case, the cost per
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Contact: Bruce L. Davidson, M.D.
206-215-2500
JAMA and Archives Journals
8-Feb-2005

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