Volume 9, Number 8, November 2002

Clopidogrel in clinical practice – primary care
Krishna Korlipara

Recent government guidelines have endorsed the need to improve the management of vascular disease, which represents an enormous burden to the UK health service. Antiplatelet agents play a key role in the management of the disease, but are currently underprescribed. Aspirin remains the accepted first-line therapy for this patient group but there is a clear need for other, more effective, antiplatelet regimens, including clopidogrel. Clopidogrel should be considered for secondary prevention in patients with a history of symptomatic atherothrombotic disease (ischaemic stroke, myocardial infarction or symptomatic peripheral vascular disease) and two or more additional risk factors for further events, for those patients who have had an event while taking aspirin and for those who are aspirin-intolerant. In addition, in line with its recently extended licence, clopidogrel may now be considered in combination with aspirin for patients with unstable angina or non-ST elevation myocardial infarction. When deciding on the optimal duration of clopidogrel treatment, GPs should assess each patient’s risk of experiencing a further event. The developing role of primary care organisations as service providers for both primary and secondary care should facilitate more consistent pathways of care and prescribing practices across all the health sectors, and in particular vascular disease.

Br J Cardiol 2002;9:S20-S25.

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