Technology Appraisal Guidance No. 210
Source: National Institute for Health and Care Excellence
This guidance applies to people who have had an occlusive vascular event, or who have established peripheral arterial disease. For people who have had a myocardial infarction, this guidance follows on from the recommendations for clopidogrel in combination with low-dose aspirin in NICE clinical guidelines 48 and 94. This guidance does not apply to people who have had, or are at risk of, a stroke associated with atrial fibrillation, or who need treatment to prevent occlusive events after coronary revascularisation or carotid artery procedures.
1.1 Clopidogrel is recommended as an option to prevent occlusive vascular events:
- for people who have had an ischaemic stroke or who have peripheral arterial disease or multivascular disease or
- for people who have had a myocardial infarction only if aspirin is contraindicated or not tolerated
1.2 Modified-release dipyridamole in combination with aspirin is recommended as an option to prevent occlusive vascular events:
- for people who have had a transient ischaemic attack or
- for people who have had an ischaemic stroke only if clopidogrel is contraindicated or not tolerated
1.3 Modified-release dipyridamole alone is recommended as an option to prevent occlusive vascular events:
- for people who have had an ischaemic stroke only if aspirin and clopidogrel are contraindicated or not tolerated or
- for people who have had a transient ischaemic attack only if aspirin is contraindicated or not tolerated.
1.4 Treatment with clopidogrel to prevent occlusive vascular events should be started with the least costly licensed preparation.
1.5 People currently receiving clopidogrel or modified-release dipyridamole either with or without aspirin outside the criteria in 1.1, 1.2 and 1.3 should have the option to continue treatment until they and their clinicians consider it appropriate to stop.
The guidance shown above constitutes Section 1 of the full document. A copy of the full document and a summary of the evidence is available on the Internet at
An abridged version of this guidance (a 'quick reference guide') is also available. Printed copies of the quick reference guide can be obtained by ing 0845 003 7783 or emailingand quoting reference number N2394. It is also available on the Internet at
This guidance represents the view of the Institute which was arrived at after careful consideration of the available evidence. Health professionals are expected to fully take it into account when exercising their clinical judgement. This guidance does not, however, override the individual responsibility of health professionals to make appropriate decisions in the circumstances of the individual patient, in consultation with the patient and/or guardian or carer.
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Enquiries concerning the guidance should be addressed to: National Institute for Health and Care Excellence, MidCity Place, 71 High Holborn, London WC1V 6NA. email:
Clopidogrel and Modified-Release Dipyridamole in the Prevention of Occlusive Vascular Events: Review of NICE Technology Appraisal Guidance 90.
Issue Date: December 2010