In guidance now out for consultation, clopidogrel can be offered to patients who have had ischaemic stroke, peripheral arterial disease (PAD) or multivascular disease. But it is only recommended for MI if aspirin is unsuitable.
Modified-release dipyridamole plus aspirin may be considered for patients who have had a TIA, NICE advises in the proposals.
For stroke patients, this combination should be recommended only when clopidogrel is not tolerated or contraindicated. It should be offered alone only when treatment with clopidogrel and aspirin are unsuitable in this patient group.
Professor Peter Littlejohns, clinical and public health director at NICE, said the institute could recommend the drug because the price had fallen since it became available as a generic.
He said the draft guidance ‘had the potential to have a significant impact on the treatment of many thousands of patients in England and Wales’.