Guidance for the use and prescribing of PCSK9 inhibitors

Primary care guidance for the prescribing and supply of Inclisiran

Inclisiran for the treatment of familial or non-familial hyperlipidaemia in secondary prevention of CVD

Summary of national guidance for lipid management for primary and secondary prevention of cardiovascular disease

NHS South West Strategic Clinical Network - Top tips for managing AF

Clinical guidelines for Secondary Prevention after Stroke or TIA

Inhixa (enoxaparin biosimilar) Information sheet

Guidance on the use of glycoprotein IIb / IIIa inhibitors in the treatment of acute coronary syndromes was issued by NICE in September 2002. TA47

1. Enteric coated aspirin tablets are generally not recommended.

2. MHRA advice (Drug Safety Update October 2009): If aspirin is used in primary prevention, the balance of benefits and risks should be considered for each individual, particularly the presence of risk factors for vascular disease (including conditions such as diabetes) and the risk of gastrointestinal bleeding.

3. NICE recommend “In patients who are taking low dose aspirin, the benefit of using COX-2 selective agents (to decrease gastrointestinal toxicity) is reduced. Prescribing COX-2 selective agents preferentially over standard NSAIDs in this situation is therefore not justified on current evidence.” In addition CSM advice is that COX-2 selective agents should not be prescribed in patients with established IHD, cerebrovascular disease or moderate heart failure.

4. Guidance on prasugrel for the treatment of acute coronary syndromes with percutaneous coronary intervention was issued by NICE in October 2009 http://guidance.nice.org.uk/TA182

5. MHRA Drug Safety Update May 2011: prescribers should be aware of the potential risk of rare but serious hypersensitivity reactions with prasugrel and should monitor for signs in all patients, including those with a previous known history of hypersensitivity reactions to thienopyridines. When prescribing prasugrel, inform patients of the potential risk of hypersensitivity reactions, including angioedema.

Guidance on the use of glycoprotein IIb / IIIa inhibitors in the treatment of acute coronary syndromes was issued by NICE in September 2002.

1. Enteric coated aspirin tablets are generally not recommended.

2. MHRA advice (Drug Safety Update October 2009): If aspirin is used in primary prevention, the balance of benefits and risks should be considered for each individual, particularly the presence of risk factors for vascular disease (including conditions such as diabetes) and the risk of gastrointestinal bleeding.

3. NICE recommend “In patients who are taking low dose aspirin, the benefit of using COX-2 selective agents (to decrease gastrointestinal toxicity) is reduced. Prescribing COX-2 selective agents preferentially over standard NSAIDs in this situation is therefore not justified on current evidence.” In addition CSM advice is that COX-2 selective agents should not be prescribed in patients with established IHD, cerebrovascular disease or moderate heart failure.

4. Guidance on prasugrel for the treatment of acute coronary syndromes with percutaneous coronary intervention was issued by NICE in October 2009 http://guidance.nice.org.uk/TA182 From RCHT the default position is to use prasugrel for 4 weeks post PPCI and then change to clopidogrel. For those patients deemed by the interventionist to be at particularly high risk of stent thrombosis it was agreed that these patients would remain on prasugrel for 12 months.

5. MHRA Drug Safety Update May 2011: prescribers should be aware of the potential risk of rare but serious hypersensitivity reactions with prasugrel and should monitor for signs in all patients, including those with a previous known history of hypersensitivity reactions to thienopyridines When prescribing prasugrel, inform patients of the potential risk of hypersensitivity reactions, including angioedema

6. NICE TAG 210 (December 2010) is a review of clopidogrel and modified-release dipyridamole for the prevention of occlusive vascular events, noting that this revised guidance does NOT apply to those who have had, or are at risk of, a stroke associated with AF, or who need treatment to prevent occlusive events after coronary revasularisation or carotid artery procedures. Choice of drugs and treatment duration in this 2010 guidance has changed from the previous NICE TAG issued in 2005.

• After the initial event of an acute confirmed ischaemic stroke or TIA has been treated with aspirin 300mg daily for 2 weeks, there has been local agreement that aspirin will be then changed to clopidogrel 75mg daily as first line option to prevent occlusive vascular events for people who have had an ischaemic stroke AND for people who have had a TIA. This local recommendation is different to (and simpler than) the NICE recommendation of M/R Dipyridamole in combination with aspirin after TIA.
• If clopidogrel is contraindicated or not tolerated, then M/R dipyridamole in combination with aspirin is an option.