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8B6P. Clopidogrel prophylaxis
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
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.
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
NICE clinical guideline CG147. Lower limb PAD 2012
See indicator wording for requirement criteria.
Patients already prescribed an anti-coagulant will be excluded from the indicator.
Prepared By Jean Keenan