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Gold, incentives and meh

Making good use of a medical student

GPs face confusion over the use of antiplatelet drugs following a review of the evidence that directly contradicts NICE recommendations.

The review, in Drug and Therapeutics Bulletin, concluded the evidence to support combined dipyridamole and aspirin in patients with a history of stroke or TIA was 'not compelling', despite recent guidelines from NICE recommending use of the combination for two years after an event.

Instead, the DTB said GPs should prescribe aspirin 75mg/day with, if necessary, a proton pump inhibitor.

The DTB reviewers also concluded they were 'not convinced' that clopidogrel offered any advantage over aspirin in patients with a history of stroke except in patients with aspirin hypersensitivity.

DTB suggested adding a PPI was a better option.

Dr John Pittard, a cardiology GP in Staines, Middlesex, said he supported the DTB conclusions on dipyridamole.

But he was less supportive of the DTB clopidogrel advice.

'For general intolerance, which counts for about 15 per cent of patients, we can't worry about guidelines ­ we have to worry about the best for the patient.'

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