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Greenhalgh J, Bagust A, Boland A, et al. Clopidogrel and Modified-Release Dipyridamole for the Prevention of Occlusive Vascular Events (Review of Technology Appraisal No. 90): A Systematic Review and Economic Analysis. Southampton (UK): NIHR Journals Library; 2011 Sep. (Health Technology Assessment, No. 15.31.)

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Clopidogrel and Modified-Release Dipyridamole for the Prevention of Occlusive Vascular Events (Review of Technology Appraisal No. 90): A Systematic Review and Economic Analysis.

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6Conclusions

For patients with ischaemic stroke/TIA, MRD + ASA followed by ASA, followed by clopidogrel, appears to be a cost-effective approach to the prevention of future occlusive vascular events.

For patients with MI, ASA followed by clopidogrel appears to be a cost-effective approach to the prevention of future occlusive vascular events.

For patients with established peripheral arterial disease or multivascular disease, clopidogrel followed by ASA appears to be a cost-effective approach to the prevention of future occlusive vascular events.

Suggested research

It is suggested that any future trials in this area should distinguish between patients with single vascular bed and multivascular disease, that definitions of multivascular disease should be prespecified (ideally using a common standard), and that triallists should ensure that trials are sufficiently powered over an extended follow-up period to allow detection of treatment differences between subgroups of patients. To facilitate comparison of primary and secondary outcomes across relevant trials, all outcomes need to be reported consistently and at key time points.

It would be most valuable to have well-audited data on a defined patient group from a long-term clinical registry of all UK patients treated with antiplatelet agents. Such a data source could provide a basis for research and audit to inform future assessments of antiplatelet agents in patients with single vascular bed and multivascular disease over the long term.

© 2011, Crown Copyright.

Included under terms of UK Non-commercial Government License.

Bookshelf ID: NBK99910

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