Performance Measurement Network

Question: What dose of enoxaparin is acceptable for use as antithrombotic therapy.

Enoxaparin is a medication listed in Appendix C, Table 8.2. Is a higher dose of enoxaparin acceptable for use as an antithrombotic therapy by end of hospital day 2? Abstraction guidelines state, "Lovenox SQ for VTE prophylaxis (i.e. enoxaparin SQ 40 mg once daily; enoxaparin SQ 30 mg Q12 hours) is not sufficient. If no other antithrombotic therapy is administered by the end of hospital day 2, select “No.”

Answer:

For STK-5 Antithrombotic Therapy By End of Hospital Day 2, aspirin 325mg is the antithrombotic medication of choice per the AHA/ASA clinical guideline recommendations. Anticoagulants at doses prescribed for VTE prophylaxis are not acceptable antithrombotic therapy for stroke patients (i.e., stroke patients need BOTH antithrombotic therapy (STK-5) and VTE prophylaxis (STK-1)); therefore, the abstraction note about "Lovenox SQ 40 mg once daily or enoxaparin SQ 30 mg Q12 hours is not sufficient" for Antithrombotic Therapy Administered By End of Hospital Day 2. Lovenox at higher doses than those specified in the note would be acceptable.

For STK-2 Antithrombotic Therapy Prescribed at Discharge, Plavix or aspirin are most frequently prescribed. Lovenox is an unlikely choice for longterm antithrombotic therapy since it is a SQ injection, unless the patient is bedridden / LTC / SNF patient. The Lovenox note for abstraction is specific to STK-5 Antithrombotic Therapy Administered By End of Hospital Day 2.

Question Details
Focus area(s): Chart Abstracted Measure Specifications – Clinical
Related documents: STK-2, STK-5, Antithrombotic Therapy Prescribed at Discharge
Manual: Future Manual (data collection period has not yet started)
File:

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