120 CHAPTER 2.3 Table 2. Continued. Coding principle Examplesa Solution based on ICD-10 coding 5 STOPP C8/C9 ‘Vitamin K antagonist, direct thrombin inhibitor or factor Xa inhibitor for first deep venous thrombosis/pulmonary embolus…’ STOPP B6 Loop diuretic as first line treatment of hypertension’ Not applicable if diagnosis ‘atrial fibrillation’ is present: anticoagulant more likely prescribed for this condition. I48 ‘Atrial fibrillation and flutter’ was added as an optional excluding condition to trigger this rule. Not applicable in case of concomitant heart failure. Heart failure (I50) added as an optional excluding condition for this rule. aThe examples are randomly selected from all coded criteria to illustrate the process of consensus, based on the coding principles. Similar decisions were made for several other criteria and codings. These decisions and their rationale are displayed below each corresponding STOPP/START criterion in Supplementary Information SI1. *The asterisk indicates that all subcategories starting with the letter/number combinations prior to the asterisk are included. Table 3. Criteria not coded. STOPP criterion Addressed disease/ diagnosis Concerning- medication (-group) Reason for the impossibility to code A1, A2 - Any drug without indication or beyond recommended duration Not possible to specify and code A3 - Any duplicated drug class Too comprehensive to code. Also, some duplicated drug classes are justi- fied (e.g. concurrent use of aspirin and clopidogrel shortly after coronary stent) L3 Breakthrough pain Long-acting opioids without short acting opioids Database related limitation. Long-acting and short-acting opioids cannot be distinguished, due to similar ATC codes. Not all textual criteria could be converted into algorithms due to limitations in the coding databases as well as the presence of uncodable textual elements in the STOPP/START-criteria themselves. As a result, some criteria could not be coded at all (Table 3); others could be partially coded, leaving some uncodable elements out of the algorithms, thereby resulting in a simplification of the criterion. An overview of all optional (excluding) conditions included in the final algorithms is displayed in Table 4. Table 4. An overview of all optional (excluding) conditions included in the final algorithms.
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