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Peripheral Arterial Disease (PAD)

Patient is excluded if prescribed Warfarin in last 15 months for a pre-existing condition

bs...%
8B2K. Anticoagulant prescribed by third party

Salicylate contra-indications: persistent

14LK. H/O: aspirin allergy
ZV148 [V]Personal history of aspirin allergy
U6051 [X]Salicylates causing adverse effects in therapeutic use
TJ53. Adverse reaction to salicylates

Salicylate contra-indications: expiring (15 months)

8I24. Aspirin prophylaxis contra-indicated
8I38. Aspirin prophylaxis refused
8I66. Aspirin not indicated
8I70. Aspirin not tolerated
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Clopidogrel contraindications: persistent

14LQ. H/O: clopidogrel allergy
U6048 [X]Clopidogrel causing adverse effects in therapeutic use
ZV14B [V]Personal history of clopidogrel allergy

Clopidogrel contraindications: expiring (15 months)

8I2K. Clopidogrel contraindicated
8I3R. Clopidogrel declined
8I6B. Clopidogrel not indicated
8I72. Clopidogrel not tolerated

OTC salicylate codes ( in last 15 months)

67I8. Advice about taking aspirin
8B63. Salicylate prophylaxis
8B3T. Over the counter aspirin therapy

Salicylate prescription codes (prescribed in last 15 months)

bu2..%
di1..%
j11..%
blm..%
bu4..%

Clopidogrel prescription codes (prescribed in last 15 months)

bu5..%
8B6P. Clopidogrel prophylaxis

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Peripheral Arterial Disease diagnosis codes

G73.. Other peripheral vascular disease
G73y. Other specified peripheral vascular disease (v26)
G73z. Peripheral vascular disease NOS
G73z0 Intermittent claudication
G73zz Peripheral vascular disease NOS
Gyu74 [X]Other specified peripheral vascular diseases
G734. Peripheral arterial disease

Peripheral Arterial Disease exception reporting codes

This exception is only applicable for the first ‘ever’ diagnosis of PAD for the patient. For a subsequent diagnosis, this exception rule is not considered.

9hS.. Exception reporting: peripheral arterial disease quality indicators
9hS0. Excepted from peripheral arterial disease quality indicators: patient unsuitable
9hS1. Excepted from peripheral arterial disease quality indicators: informed dissent
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Peripheral Arterial Disease 004.1 Rationale

Most cases of PAD are managed in primary care. The focus of management is on the secondary prevention of cardiovascular disease. It is important to reduce the cardiovascular complications of atherosclerosis through appropriate cardiovascular risk factor management. Two small UK studies assessing clinical risk management based on the medical records of patients with PAD suggest that these patients have poor hypertension control, use low levels of statin and antiplatelet therapy, and receive low levels of smoking cessation advice. This indicator addresses the issue of prescribing antiplatelet therapy.
Bradley L, Kirker SGB (2006) Secondary prevention of arteriosclerosis in lower limb vascular amputees: a missed opportunity. European Journal of Vascular and Endovascular Surgery 32: 491-493
Khan S, Flather M, Mister R et al. (2007) Characteristics and treatments of patients with peripheral arterial disease referred to UK vascular clinics: results of a prospective registry. European Journal of Vascular and Endovascular Surgery 33: 442-450

The SIGN clinical guideline on PAD states that antiplatelet therapy is recommended for patients with symptomatic PAD.
Scottish Intercollegiate Guidelines Network (2006) Diagnosis and management of peripheral arterial disease: a national clinical guideline. Available from www.sign.ac.uk/pdf/sign89.pdf

The Antithrombotic Trialists’ Collaboration meta-analysis showed a 23 per cent reduction in serious vascular events in a subgroup of 9214 people with PAD who were treated with antiplatelet drugs.
Antithrombotics Trialists' Collaboration (2002) Collaborative meta-analysis or randomised trials of antiplatelet therapy for prevention of death, myocardial infarction and stroke in high risk patients. British Medical Journal 324: 71-86


Similar results were found in a second systematic review of the effects of antiplatelet therapy in patients with PAD.
National Institute for Health and Clinical Excellence (2010) Clopidogrel and modified-release dipyridamole for the prevention of occlusive vascular events. NICE technology appraisal guidance 210. London: National Institute for Health and Clinical Excellence. Available from www.nice.org.uk/guidance/TA210


When comparing the effects of different antiplatelet drugs, the Antithrombotic Trialists’ Collaboration found no evidence statistically significant differences between anti-platelets.

NICE has published technology appraisal guidance on the use of clopidogrel and modifiedrelease dipyridamole to prevent occlusive vascular events (ischaemic stroke, TIA and MI). It recommends clopidogrel as an option to prevent occlusive vascular events in patients who have established PAD. www.nice.org.uk/guidance/TA210

Further information:
NICE clinical guideline CG147. Lower limb PAD 2012

Peripheral Arterial Disease 004.2 Reporting and verification

See indicator wording for requirement criteria.

Patients already prescribed an anti-coagulant will be excluded from the indicator.

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Prepared By Jean Keenan