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NICE endorses wider use of clopidogrel

By Lilian Anekwe

GPs are to be given the go-ahead to prescribe clopidogrel for the prevention of vascular events in people who have had a previous stroke or have peripheral arterial disease.

Final draft guidance published by NICE recommends wider use of clopidogrel for prevention of occlusive vascular events – ischaemic stroke, transient ischaemic attack or heart attack – in people who have a history of ischaemic stroke or have a diagnosis of PAD.

The guidance, which updates 2005 NICE guidance, recommends clopidogrel as an option to prevent occlusive vascular events for people who have had an ischaemic stroke or who have PAD or cardiovascular disease in more than one vascular site.

GPs will also be able to prescribe clopidogrel to people who have had a myocardial infarction, but only if aspirin is contraindicated or not tolerated.

Clopidogrel is now available in generic form and NICE tells GPs to ensure they initiate patients ‘with the least costly licensed preparation’, which it estimates will cost £3.40 per patient for 30-day treatment on the 75mg dose, compared with £35.64 for branded clopidogrel.

Dr Andrew Mimnagh, a GP in Liverpool and board member of the campaign group Target PAD, said there was good evidence for use of clopidogrel instead of aspirin: ‘It’s been the professional body of opinion for some time. The major benefit is reduction in cardiovascular deaths and events. It does not greatly improve symptom relief, surgical interventions have the best evidence for that, but it does prevent limb salvage procedures and has mortality benefits over 10 years compared with aspirin.’

The final draft also recommends modified-release dipyridamole in combination with aspirin in patients who have had a TIA, or an ischaemic stroke if clopidogrel is contraindicated or not tolerated. Modified-release dipyridamole can be used alone in patients who have had an ischaemic stroke if aspirin and clopidogrel are contraindicated or not tolerated, or who have had TIA if aspirin is contraindicated or not tolerated.

Dr Andrew Mimnagh