Vascular disease - clopidogrel and dipyridamole

1. Guidance

This guidance applies to people who have had an occlusive vascular event, or who have symptomatic peripheral arterial disease. This guidance does not apply to people who have had, or are at risk of, a stroke associated with atrial fibrillation, or who require treatment to prevent occlusive events after coronary revascularisation or carotid artery procedures.

1.1. As part of the prevention of occlusive vascular events:

1.1.1 the combination of modified-release (MR) dipyridamole and aspirin is recommended for people who have had an ischaemic stroke or a transient ischaemic attack for a period of 2 years from the most recent event. Thereafter, or if MR dipyridamole is not tolerated, preventative therapy should revert to standard care (including long-term treatment with low-dose aspirin)

1.1.2 clopidogrel alone (within its licensed indications) is recommended for people who are intolerant of low-dose aspirin and either have experienced an occlusive vascular event or have symptomatic peripheral arterial disease.

1.2. For the purposes of this guidance, aspirin intolerance is defined as either of the following:

• proven hypersensitivity to aspirin-containing medicines
• history of severe dyspepsia induced by low-dose aspirin.