NICE has published final draft guidance recommending the wider use of clopidogrel for the prevention of occlusive vascular events (ischaemic stroke, transient ischaemic attack or heart attack) in people who have previously had an ischaemic stroke, or who have been diagnosed with peripheral arterial disease (PAD).
The draft guidance recommends:
• Clopidogrel (initiated with the least costly licensed preparation) as an option for people who have had an ischaemic stroke, who have PAD or who have multivascular disease. Clopidogrel is only recommended as an option for people who have had a heart attack if aspirin is contraindicated or not tolerated.
• Modified-release dipyridamole plus aspirin as an option for people who have had a TIA. For people who have had an ischaemic stroke, modified-release dipyridamole plus aspirin should only be used where clopidogrel is contraindicated or not tolerated.
• Modified-release dipyridamole alone as an option for people who have had an ischaemic stroke only where treatment with aspirin and clopidogrel is contraindicated or not tolerated.
