• FCMS
  • Doncaster and Bassetlaw Teaching Hospitals NHS Foundation Trust
  • Rotherham Doncaster and South Humber NHS Foundation Trust
  • Nottingham and Nottinghamshire
  • South Yorkshire ICB

For information relating to Clopidogrel Genetic testing on the SY MO website  Click Here

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Aspirin Dispersible Tablets 75mg

Acute ischaemic stroke, Secondary prevention of cardiovascular disease, Following coronary artery bypass surgery, Management of ACS (Acute coronary syndrome) - as appropriate

Product can be purchased Over The Counter

Please Note:

Aspirin for prevention of pre-eclampsia in pregnancy

 Aspirin doesn't have a UK marketing authorisation for prevention of pre-eclampsia in pregnancy (off-licence use) and cannot be purchased OTC. However, it is a common clinical practice to prescribe aspirin for prevention of pre-eclampsia in pregnancy in line with the NICE NG133

See NICE's information on prescribing medicines. ( keep this statement if needed)

The dose advised should be to take aspirin (75-150 mg) once a day from 12 weeks of pregnancy until 36 weeks of pregnancy, to reduce your chance of developing pre-eclampsia.

There is risk of developing pre-eclampsia if more than one of the following applies:

  •  first pregnancy
  •  age 40 or over

 last pregnancy was more than 10 years ago

  • overweight – a BMI (body mass index) of 35 or more
  •  mother or sister had pre-eclampsia during her pregnancy

carrying more than one baby (twins, triplets or more).

If there is more than one of these risk factors,  aspirin should be given once a day from 12 weeks of pregnancy on advice from the obstetric consultant.  ( RCOG Patient Information Leaflet ) 

Aspirin is also used as an antithrombotic in pregnancy to minimise recurrent foetal loss . ( RCOG clinical guidelines)

Pack Price
28 tablet £0.67

Atherosclerotic events (Prevention)

MHRA Drug Safety Update -risk of acquired haemophilia
December 2013

Pack Price
28 tablet £0.91

STEMI, NSTEMI in combination with low dose aspirin (including stent placement following PCI) and Acute Coronary Syndrome.

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.

NICE TA 210
Clopidogrel and modified-release dipyridamole for the prevention of occlusive vascular events December 2010

* Concomitant use of clopidogrel and omeprazole or esomeprazole is to be discouraged unless considered essential
* Doctors should check whether patients who are taking clopidogrel are also buying over-the-counter omeprazole and consider whether other gastrointestinal therapies would be more suitable
* Pharmacists should check whether patients buying omeprazole are also taking clopidogrel
* Consider PPIs other than omeprazole or esomeprazole in patients who are taking clopidogrel. Other gastrointestinal therapy such as H2 blockers (except cimetidine) or antacids may be more suitable in some patients
* Discourage concomitant use of other known CYP2C19-inhibiting medicines with clopidogrel because these are expected to have a similar effect to omeprazole and esomeprazole (CYP2C19 inhibitors include fluvoxamine, fluoxetine, moclobemide, voriconazole, fluconazole, ticlopidine, ciprofloxacin, cimetidine, carbamazepine, oxcarbazepine, and chloramphenicol)

MHRA Drug Safety Update Volume 3 Issue 9 April 2010

 

Pack Price
28 tablet £0.91

Ticagrelor Tablets

Prevention of atherothrombotic events in patients with acute coronary syndrome (including STEMI, NSTEMI and unstable angina)

Myocardial infarction (MI)-history of, with a high risk of developing an atherothrombotic event

Ticagrelor for preventing atherothrombotic events after myocardial infarction
December 2016

NICE NG185    Acute coronary syndromes

The 1st 28 days supply will be provided by the initiating Hospital
 Duration is for 12months post event and details should be added to the repeat prescription to ensure review occurs at this point.
Renal function should be checked 4 weeks after initiation - it is anticipated that the Primary Care prescriber will undertake this monitoring unless the patient attends a follow up Cardiology appointment within this time scale.
 Mild to moderate dyspnoea may occur in a very small number of patients - if this occurs contact Cardiology directly
The concomitant use of ticagrelor with doses of simvastatin greater than 40 mg is not recommended
Appropriate clinical and/or laboratory monitoring is recommended when giving digoxin or cyclosporin concomitantly with ticagrelor - contact Cardiology for further advice.

APC May 2012

Pack Price
56 tablet £54.60

Aspirin Dispersible Tablets 300mg

Acute ischaemic stroke, Following coronary artery bypass surgery, Management of ACS (Acute coronary syndrome)

 

Pack Price
32 tablet £0.90

Dipyridamole 200mg MR Capsules

Dipyridamole is now rarely used in practice. It is used only in those patients with ischaemic stroke or TIA who are intolerant to clopidogrel where the MR capsule should be used in conjunction with aspirin. In patients intolerant to both clopidogrel and aspirin, dipyridamole m/r can be used as a sole agent.
Dose:
Dipyridamole 200mg MR capsules – one twice daily

Special Container pack of 60 capsules 

Acute ischaemic stroke, Management of ACS (Acute coronary syndrome) - As appropriate

 

Pack Price
10 suppository £55.68

Prasugrel Tablets

Prevention of atherothrombotic events in patients with acute coronary syndrome

NICE TA317 Prasugrel with percutaneous coronary intervention for treating acute coronary syndromes

1.1 Prasugrel 10 mg in combination with aspirin is recommended as an option within its marketing authorisation, that is, for preventing atherothrombotic events in adults with acute coronary syndrome (unstable angina [UA], non-ST segment elevation myocardial infarction [NSTEMI] or ST segment elevation myocardial infarction [STEMI]) having primary or delayed percutaneous coronary intervention.

MHRA Drug Safety Update Incresed risk of bleeding - information on timing of loading dose when used in the acute management of patients experiencing unstable angina or NSTEMI and undergoing coronary angiography within 48hours of admission.

Yorkshire & the Humber Cardiovascular Strategic Clinical Network (South) Guidance can be found here
February 2014


NICE CG172 Myocardial infarction: cardiac rehabilitation and prevention of further cardiovascular disease

Treatment with Prasugrel should be initiated in secondary care. It is then appropriate for continued prescribing in primary care. The duration of treament should be specified by secondary care in the original communication.

Prasugrel may be suitable for a limited number of patients (e.g. patients who require immediate percutaneous coronary intervention or patients who have experienced stent thrombosis despite previous clopidogrel treatment). However, for each individual, the potential benefits of prasugrel must be carefully balanced against the risk of bleeding.

Prasugrel is not recommended for patients over the age of 75 years or patients weighing less then 60kg because these patients have a high risk of bleeding.

It is contraindicated in patients with a history of stroke or transient ischaemic attack.

Prasugrel (Efient) for acute coronary syndrome managed with percutaneous coronary intervention
MTRAC Verdict & Summary February 2010

Pack Price
28 tablet £2.85
Pack Price
28 tablet £17.26

Acute Coronary Syndrome (ACS) - Moderate and high-risk

Rationale: 1,2,4

*Hospital Use only*

 

Monoclonal antibody

Rationale: 1,6

 

 

Prevention of early myocardial infarction in patients presenting with unstable angina or non-Q-wave myocardial infarction. 

Moderate- and high-risk acute coronary syndromes (ACS)

Brand: Integrilin

Rationale: 1

NICE Guidance 

 

Review Date: 01/05/2026

Pulmonary arterial hypertension

Brand : Uptravi

Rationale 1,2

NHSE Clinical commissioning policy
Selexipag in an option for treating PAH
Dec 2018

 

Review Date: 01/10/2025

Thrombotic cardiovascular events in adult patients with coronary artery disease (reduction of)

Brand : Kengrexal

Rationale 2

NICE TA351 (Terminated)

NICE is unable to make a recommendation about the use in the NHS of cangrelor for reducing atherothrombotic events in people undergoing percutaneous coronary intervention or awaiting surgery requiring interruption of anti-platelet therapy.