Performance Measurement Network

Question: STK-5 Antithrombotic - LOVENOX SQ

If Lovenox is no longer acceptable or considered as an Antithrombotic to satisfy STK-5, (new bullet stating Lovenox also used for VTE Prophylaxis is NOT sufficient why is Lovenox still listed under Appendix C, Table 8.2 for acceptable Antithrombotic Medications for Stroke (2016A?

Please advise, as our current facility's medical practice/order sets allow for Lovenox to satisfy both STK-5 requirements, as well as STK-1 VTE Prophylaxis.

Starting July 1, 2016, does satisfying the STK-5 measure now require a written statement in the medical record from the MD,NP or ANP acknowledging the dual purpose of Lovenox? Would it be sufficient to meet the measure if an order reads:"Lovenox 30mg SQ QD for both VTE prophylaxis and antithrombotic therapy"?

What if we have a statement in the H&P Plan of Care acknowledging the use of Lovenox for both purposes, is that sufficient?

Thank you))

Answer:

Anticoagulants at doses to prevent VTE prophylaxis (Lovenox SQ) do not meet STK-5. This point is included in the rationale for the measure and has not changed since the measure set was implemented in 2005. Stroke patients should receive both VTE prophylaxis (heparin SQ or Lovenox recommended, SCDs if contraindicated) AND antithrombotic therapy (ASA recommended). A single dose of Lovenox does NOT meet both STK-1 and STK-5. Notes for abstraction have been modified to emphasize this point. If you have been taking credit for both measures, please correct with discharge on and after July 1, 2016 because it is not clinically appropriate care (Please refer to the AHA/ASA Guidelines for the Early Management of Patients with Ischemic Stroke, Jauch, 2013).

Table 8.2 Antithrombotic Medications-Stroke is used for abstraction of both STK-5 and STK-2 Discharged on Antithrombotic Therapy. SQ Lovenox may be appropriate long-term therapy for some stroke patients, e.g., LTC, hospice.

Hope this clarifies for you. Thank you for your inquiry.

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

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