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NICE clopidogrel guidance review brought forward

By Nigel Praities

NICE has responded to new trial data by bringing forward a review of its antiplatelet guidance, in a move that could push clopidogrel to the front line of stroke prevention.

The institute was due to review its technology appraisal on use of the drug to prevent strokes and heart attacks in 2010, but will start a year earlier after responses from a number of stakeholders.

A technology appraisal released in 2005 recommended a 2-year course of modified-release dipyridamole and aspirin for patients who had had an ischaemic stroke or transient ischaemic attack – reserving clopidogrel for patients intolerant of aspirin.

But the PROFESS trial, released at the European Stroke Conference earlier this year, failed to show aspirin and extended-release dipyridamole was as efficacious as clopidogrel in preventing stroke recurrence after a first event.

The new evidence seems to have prompted the decision from NICE, which was urged by the British Association of Stroke Physicians, the Vascular Society of Great Britain and the manufacturers of clopidogrel – Bristol-Myers Squibb and sanofi-aventis – to reconsider its guidance in the light of new trial evidence.

The BASP had urged: ‘The review should not be delayed for so long. The results of the PROFESS trial will clearly have major implications for this particular guideline.'

Dr Stewart Findlay, treasurer of the Primary Care Cardiovascular Society and a GP in Bishop Auckland, County Durham,said: ‘GPs need clear advice in this area.'

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