Prescribing Advice for GPs

An NHS Prescribing Advisers' Blog

National Antiplatelet Guidance Published

Clopidogrel (Plavix) is being used much more as time passes as an alternative when patients cannot tolerate Aspirin as an antiplatelet follwing a cardiovascular event, such as a heart attack or stroke.

NICE recently published a Technology Appraisal in respect of Clopidogrel and Dypridamole (Persantin) in occlusive vascular events. It has also been summarised by the NPC in a recent MeReC Bulletin.

In summary:

For Secondary Prevention

  • Low dose Aspirin (75mg daily) is first line and should be prescribed indefinitely
  • Dypridamole (prescribed as Asasantin) is of additional benefit for the first two years after a stroke
  • Clopidogrel is a suitable alternative to aspirin where aspirin is contraindicated or not tolerated

For Primary Prevention

  • Low dose Aspirin (75mg daily) is first line and should be considered for all patients over the age of 50 at higfh risk of CVD, provided hypertension is controlled
  • Clopidogrel and Dypridamole are neither indicated nor licensed for Primary Prevention

Action: Ensure you are using antiplatelets appropriately to ensure greatest benefit to the patient in terms of effect and safety.

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