A review by the National Institute for Health and Clinical Excellence of previous guidance has re-endorsed the use of clopidogrel and Boehringer Ingelheim’s modified-release dipyridamol for the prevention of occlusive vascular events.

New draft guidance by the cost watchdog has recommended the wider use of clopidogrel (using the least costly preparation) in National Health Service patients who have had a stroke or who have peripheral arterial disease (PAD), as well those who have cardiovascular disease in more than one area, in order to help prevent a subsequent heart attack or stroke. But the drug is only recommended for patients who have had a heart attack if they are unable to take aspirin.

A combination of modified-release dipyridamole, sold under the brand names Persantin Retard and Asasantin Retard by Boehringer Ingelheim, and aspirin has been endorsed as an option for those who have had a transient ischaemic attack (TIA), but should only be used when patients have had an ischaemic stroke where clopidogrel is contraindicated or not tolerated. The drug can also be used alone as an option following ischaemic stroke where aspirin and clopidogrel cannot be taken, the Institute said.

Heart attacks and strokes are amongst the biggest killers and causes of disability in England and Wales and, every year across the nation, around 98,000 people have a first ischaemic stroke, 65,000 people a TIA and 146,000 a heart attack, and 850,000 people aged 55-75 years have evidence of lower limb PAD. As it is known that patients who have suffered a heart attack or stroke are at a greater risk of a subsequent attack, effective preventative strategies are crucial.

Since NICE’s original guidance was published in 2005, two additional studies have assessed the use of clopidogrel and modified-release dipyridamole plus aspirin for the prevention of OVE and “both were supportive of the conclusions in that guidance”, said Professor Peter Littlejohns, Clinical and Public Health Director at NICE. In addition, the availability of generic forms of clopidogrel has generated “a marked fall in its price and this has meant that the Committee has been able to recommend that it now be used more widely”, he added.

The cost of generic clopidogrel is £5.13 for 30 days, while treatment with modified-release dipyridamol plus aspirin over the same time frame is £7.50