UK's NICE issues guidance on blood clotting drugs Plavix and Persantin/Asasantin; PMCPA consults on ABPI Code of Practice

UK drugs watchdog the National Institute for Health and Clinical Excellence (NICE) is currently reviewing its guidance on the use of the blood thinning drugs clopidogrel (French drug major Sanofi-Aventis' blockbuster drug Plavix) and modified-release dipyridamole (Persantin Retard and Asasantin Retard [combined with aspirin] from Germany's Boehringer Ingelheim) for the prevention of occlusive vascular events (OVEs), originally published in 2005. In draft guidance published for public consultation on  August 4, the NICE has recommended the wider use of clopidogrel in people who have previously had a stroke, or who have been diagnosed with a condition called peripheral arterial disease (PAD), which puts them at high risk of stroke or heart attack.

The draft guidance recommends:

' Clopidogrel (initiated with the least costly licensed preparation) as an option for people who have had an ischemic stroke, who have PAD or who have cardiovascular disease (CVD) in more than one vascular site (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 transient ischemic attack (TIA). For people who have had an ischemic 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 ischemic stroke only where treatment with aspirin and clopidogrel is contraindicated or not tolerated.

Peter Littlejohns, Clinical and Public Health Director at the NICE, said: 'We know that heart attacks and strokes are some of the biggest killers and causes of disability in England and Wales and that people who have had one heart attack or stroke are at a greater risk of having another. Since the original NICE guidance was published in 2005 there have been two further studies that have looked at the use of clopidogrel and modified-release dipyridamole plus aspirin for the prevention of occlusive vascular events. Both were supportive of the conclusions in that guidance. Further, the availability of clopidogrel as a generic preparation has seen 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. There is also evidence that the drugs continue to provide benefit beyond the two years previously suggested by the original guidance and this is reflected in the draft guidance published today.'