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
Warfarin contraindications: persistent
- 14LP. H/O: warfarin allergy
- TJ42. Adverse reaction to anticoagulants
- TJ421 Adverse reaction to warfarin sodium
- TJ422 Adverse reaction to nicoumalone
- TJ423 Adverse reaction to phenindione
- TJ42z Adverse reaction to anticoagulants NOS
- U6042 [X]Anticoagulants causing adverse effects in therapeutic use
- ZV14A [V]Personal history of warfarin allergy
Warfarin contraindications: expiring (15 months)
- 8I25. Warfarin contraindicated
- 8I3E. Warfarin declined
- 8I65. Warfarin not indicated
- 8I71. Warfarin not tolerated
- 8I2R. Anticoagulation contraindicated
- 8I3d. Anticoagulation declined
- 8I6N. Anticoagulation not indicated
- 8I7A. Anticoagulation not tolerated
-
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
- 8B6P. Clopidogrel prophylaxis
Salicylate prescription codes (prescribed in last
15 months)
- bu2..%
- di1..%
- j11..%
- blm..%
- bu4..%
Clopidogrel prescription codes (prescribed in last 15 months)
bu5..%
Warfarin prescription codes (prescribed in last 15 months)
- bs...%
- 8B2K. Anticoagulant prescribed by third party
CHD Diagnosis Codes
- G3... Ischaemic heart disease - G330z Angina decubitus NOS
- G33z. Angina pectoris NOS - G3401 Double coronary vessel disease
- G342. Atherosclerotic cardiovascular disease - G366. Thrombosis of atrium,
auricular appendage, and ventricle as current complications following acute
myocardial infarction
- G38.. Postoperative myocardial infarction - G3z.. Ischaemic heart disease
NOS
- Gyu3. [X]Ischaemic heart diseases
- Gyu30 [X]Other forms of angina pectoris
- Gyu31 [X]Other current complications following acute myocardial infarction
- Gyu32 [X]Other forms of acute ischaemic heart disease
- Gyu33 [X]Other forms of chronic ischaemic heart disease
- Gyu34 [X]Acute transmural myocardial infarction of unspecified site
- Gyu35 [X]Subsequent myocardial infarction of other sites
- Gyu36 [X]Subsequent myocardial infarction of unspecified site
CHD exception reporting codes (In last 15 months)
- 9h0.. Exception reporting: CHD quality indicators
- 9h01. Excepted from CHD quality indicators: Patient unsuitable
- 9h02. Excepted from CHD quality indicators: Informed dissent
CHD 9.1 Rationale
Aspirin (75–150 mg per day) should be given routinely and continued
for life in all patients with CHD unless there is a contraindication. Clopidogrel
(75 mg/day) is an effective alternative in patients with contraindications to
aspirin, or who are intolerant of aspirin. Aspirin should be avoided in patients
who are anticoagulated.
Grade A Recommendation SIGN Guidelines 96 and 97
Further information: www.sign.ac.uk/guidelines/fulltext/96/index.html
www.sign.ac.uk/guidelines/fulltext/97/index.html
Since the original GMS Guidance in 2003, NICE has released guidance
on the appropriate use of clopidogrel:
• Clopidogrel alone (within its licensed indications) is recommended
for people who are intolerant of low-dose aspirin and either have experienced
an occlusive vascular event or have symptomatic peripheral artery disease. NICE
defines aspirin intolerance as either of the following: proven hypersensitivity
to aspirin-containing medicines or history of severe dyspepsia induced by low-dose
aspirin.
• Clopidogrel, in combination with low-dose aspirin, is recommended
for use in the management of non-ST-segment-elevation acute coronary syndrome
(ACS) in people who are at moderate to high risk of myocardial infarction (MI)
or death. NICE recommends that treatment with clopidogrel in combination with
low-dose aspirin should be continued for up to 12 months after the most recent
acute episode of non-ST-segment-elevation ACS. Thereafter, standard care, including
treatment with low-dose aspirin alone, is recommended. Moderate to high risk
of MI or death in people presenting with non-ST-segment-elevation ACS can be
determined by clinical signs and symptoms, accompanied by one or both of the
following:
- the results of clinical investigations, such as new ECG changes (other
than persistent ST-segment-elevation), indicating ongoing myocardial ischaemia,
particularly dynamic or unstable patterns
- the presence of raised blood levels of markers of cardiac cell damage such
as troponin.
Further information: www.nice.org.uk/guidance/index.jsp?action=byID&r=true&o=11536
CHD 9.2 Reporting and verification
Practices should report the percentage of patients on the CHD
register who have been prescribed aspirin, clopidogrel or warfarin within the
previous 15 months or have a record of taking over-the-counter (OTC) aspirin
updated in the previous 15 months.
Prepared By Jean Keenan