Purpose Selecting antithrombotic medications for patients with Peripheral Artery Disease (PAD) involves balancing the benefits of intensified therapy against the risk of severe bleeding. The new OAC3-PAD bleeding risk score may help decision-making by characterising individual risk profiles. This study aims to stratify PAD patients into OAC3-PAD risk categories and assess alignment of current antithrombotic prescriptions with bleeding risk. Methodology This retrospective cohort study included consecutive PAD patients in a tertiary vascular unit from June 2022- June 2023. OAC3-PAD variables—age, CLTI, congestive cardiac failure, chronic kidney disease, prior bleeding, anaemia, and dementia—were extracted from electronic medical records. Descriptive statistics, and multinominal logistic regression compared antithrombotic prescribing across OAC3-PAD risk groups. Results The 425 patients were classified into OAC3-PAD bleeding risk categories: low (77, 18%), low-moderate (56, 13%), moderate-high (156, 37%), and high (136, 32%). Of the 42 patients not prescribed antithrombotic medications, only 10 were high-risk. Aspirin was the most commonly prescribed antithrombotic (131, 31%), followed by dual antiplatelet therapy (DAPT) (98, 23%). Low-dose rivaroxaban was prescribed to 47 patients (11%). High-risk patients were less likely to receive low-dose rivaroxaban (OR 0.40, 95%CI 0.18 - 0.88) or DAPT (OR 0.60, 95%CI 0.37 - 0.97), but more likely to be on oral anticoagulants (OR 5.34, 95%CI 3.20 - 8.92) compared to low-risk patients. Conclusion The OAC3-PAD bleeding risk score provides a valuable framework for stratifying PAD patients and aligning antithrombotic therapy with bleeding risk. Currently, the prescription of low dose rivaroxaban and DAPT aligns with bleeding risks, but less for oral anticoagulation. These findings highlight the need for tailored antithrombotic strategies that balance efficacy with safety based on individual bleeding risk profiles.