More patients with vascular disease to benefit from clopidogrel use
GPs will now be able to prescribe clopidogrel for the prevention of vascular events in patients who have had a previous stroke or have peripheral arterial disease, as NICE widens use of the drug.
The final guidance, which updates the previous 2005 guidance, recommends clopidogrel as an option for patients who have multivascular disease or peripheral arterial disease and for patients who have had a heart attack if aspirin is contraindicated or not tolerated.
The guidance, out today, also recommends the use of modified-release dipyridamole plus aspirin as an option for patients who have had a transient ischaemic attack, or for those who have had an ischaemic stroke, only if clopidogrel is contraindicated or not tolerated.
Dipyridamole can be given on its own if the patient has had an ischaemic stroke and treatment with aspirin and clopidogrel is contraindicated or not tolerated, or if the person has had a transient ischaemic attack and aspirin is contraindicated or not tolerated.
GPs should start patients with the least costly licensed preparation of the drug, says NICE.
Professor Peter Littlejohns, Clinical and Public Health Director at NICE, said that two major studies had been conducted since the original guidance was published, prompting an update.
“Although both new studies were supportive of the earlier NICE guidance conclusions, the availability of clopidogrel as a generic preparation and the subsequent marked fall in its price, has meant that the Committee is able to recommend that it is used more widely.
“There is also evidence that both clopidogrel and modified-release dipyridamole continue to provide benefit beyond the 2 years previously suggested.
"Today's guidance for clopidogrel and modified release dipyridamole therefore has the potential to have a significant impact on the treatment of many thousands of patients in England and Wales.”
Dr Terry McCormack, a GP in North Yorkshire and former chairman of the Primary Care Cardiovascular Society, said: “I have always used clopidogrel in stroke prevention and as a replacement for aspirin when it is not tolerated, so I welcome the new NICE guidance. Obviously it helps that it is now generic.”
“But more research is needed, however, to show us if aspirin and clopidogrel have any role in primary prevention,” he added.
15 December 2010