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aspirin in NICE's previous guidelines on MI – secondary prevention, and unstable angina and NSTEMI (these have now been replaced by NICE's guideline on acute coronary syndromes). 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.
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.
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.
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.
Treatment with clopidogrel to prevent occlusive vascular events should be started with the least costly licensed preparation.
People currently receiving clopidogrel or modified-release dipyridamole either with or without aspirin outside the criteria in sections 1.1, 1.2 and 1.3 should have the option to continue treatment until they and their clinicians consider it appropriate to stop.