Risky prescribing |
Avoidance of the following prescribing combinations: |
• Prescribing of a traditional oral NSAID or low-dose aspirin in patients with a history of peptic ulceration WITHOUT co-prescription of a gastro-protective drug. |
• Prescribing of a traditional oral NSAID in patients aged 75 or over WITHOUT co-prescription of a gastro-protective drug. |
• Prescribing of a traditional oral NSAID and aspirin in patients aged 65 or over WITHOUT co-prescription of a gastro-protective drug. |
• Prescribing of aspirin and clopidogrel in patients aged 65 or over WITHOUT co-prescription of a gastro-protective drug. |
• Prescribing of warfarin and a traditional oral NSAID WITHOUT co-prescription of a gastro-protective drug. |
• Prescribing of warfarin and low-dose aspirin or clopidogrel, WITHOUT co-prescription of a gastro-protective drug. |
• Prescribing an oral NSAID in patients with heart failure. |
• Prescribing an oral NSAID in patients prescribed both a diuretic and an ACE-inhibitor / ARB. |
• Prescribing an oral NSAID in patients with chronic kidney disease (stages 3, 4 and 5) |
Treatment targets in type 2 diabetes |
Achievement of all three recommended levels: |
• Blood pressure below 140/80 mmHg (or 130/80 mmHg if there is kidney, eye or cerebrovascular damage). |
• HbA1c value below or equal to 59 mmol/mol. |
• Cholesterol level below or equal to ≤ 4.0 mmol/l in patients who are 40 or older. |
Blood pressure targets in treated hypertension |
Aim for a target clinic blood pressure below 140/90 mmHg in people aged under 80 years with treated hypertension. |
Aim for a target clinic blood pressure below 150/90 mmHg in people aged 80 years and over with treated hypertension. |
Anticoagulation in atrial fibrillation |
In patients with atrial fibrillation who are either post-stroke, or have had a transient ischaemic attack: |
• Warfarin should be administered as the most effective thromboprophylactic agent. |
• Aspirin or dipyridamole should not be administered as thromboprophylactic agents unless indicated for the treatment of comorbidities or vascular disease. |
Those patients with AF in whom there is a record of a CHADS2 (congestive heart failure, hypertension, age >75, diabetes mellitus, and prior stroke) score of 1 should be offered anticoagulation drug therapy or anti-platelet therapy. |
Those patients with AF whose latest record of a CHADS2 score is greater than 1 should be offered anticoagulation therapy. |