Evidence to support clopidogrel use over aspirin is not convincing
Advantages of using clopidogrel over aspirin to prevent vascular events after stroke are not convincing, the Drug
and Therapeutics Bulletin concludes in its latest issue (2005;43:53).
“[Clopidogrel] should not be prescribed for patients with a history
of stroke, except for those who have genuine aspirin hypersensitivity.” It
suggests that patients who suffer severe dyspepsia with aspirin would
be better treated by adding a proton pump inhibitor rather than switching
aspirin to clopidogrel, as has been suggested in recent National Institute
for Health and Clinical Excellence guidance (PJ, 28 May, p641).
DTB also believes that the evidence to support addition of modified-release
dipyridamole to aspirin is not compelling. The bulletin recommends that
patients with a history of ischaemic stroke or transient ischaemic attack
receive aspirin (or clopidogrel if they have a genuine aspirin hypersensitivity),
a statin and drug therapy to reduce blood pressure. These should be prescribed
even if the patient’s blood pressure and cholesterol are considered
normal, it concludes.
Reperfusion The July issue of DTB also reviews methods
for restoring blood flow in acute myocardial infarction (ibid, p49).
It considers thrombolysis and percutaneous coronary intervention
and suggests that outcomes could be improved if more patients receive
thrombolysis before arriving at hospital.
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