OBJECTIVES: To compare the cost and effectiveness of aspirin with that of clopidogrel in acute myocardial infarction(AMI) patients from data of Beijing medical insurance database METHODS: We randomly selected 10% of patients diagnosed as AMI the first time during January 2012- December 2012 and then followed their inpatient records and prescription records to September 2013 from Beijing medical insurance database. We divided these patients into 5 groups according to their drug utilization records during the observation period. 1239 patients were divided into 5 groups according to the proportion of aspirin prescription by 100.0%, 60.1-99.9%, 40.0-60.0%, 0-39.9% and 0(clopidogrel only). We compared the rate of recurrences, cost of anti-platelet drugs and rate of hemorrhage events in different drug utilization groups.  The Kruskal-Wallis test and Bartlett's test were used in the analysis.  RESULTS: ±（）patients used aspirin only, 761（）patients used aspirin more(60-100%), 289（）patients used 40-60% aspirin, 116（）patients used aspirin 0-40% and 10（）patients used clopidogrel only. The MI recurrence rates for patients of different prescription groups were significantly different(p<0.01), patients with only aspirin utilization recurred less than that of patients with 60-100% aspirin and 40-60% aspirin prescription, patients with 0-40% aspirin prescription recurred less than that of patients with 60-100% aspirin prescription. The cost of anti-platelet drugs for patients of different drug groups was significantly different(p<0.01),  The hemorrhage rate of patients with only aspirin prescription was higher than that of patients with two drugs. CONCLUSIONS: A small proportion of AMI patients used only one drug for anti-platelet treatment, while most patients used both aspirin and clopidogrel. Patients who used aspirin only had lower cost of anti-platelet drugs, lower rate of recurrence and higher rate of hemorrhage events. Further studies on  cost-effectiveness for aspirin and clopidogrel would provide moret evidence.