Performance Measurement Network

Question: Lovenox in reference to STK-2, STK-5, and STK-3

Regarding: v2016A, Discharges 7/1/16 - 12/31/16: STK-5 data element "Antithrombotic Therapy Administered by End of Hospital Day 2" states that lovenox is not sufficient. I have been reading the questions and answers that have been posted in reference to this, but there are still a few questions that I have. (1 Regarding the STK-5 questions posted in reference to lovenox, the answers provided on the website refer to STK-2 as well (Discharged on Antithrombotic Therapy. The STK-2 data element "Antithrombotic Therapy Prescribed at Discharge" refers you to appendix C, table 8.2, where lovenox is included. Can you please clarify?

(2)The data element "Antithrombotic Therapy Administered by End of Hospital Day 2" refers you to appendix C, table 8.2, where lovenox is listed under the title "Antithrombotic Medications - Stroke". Can you please clarify?

Thank you!

Answer:

The list of medications included in Table 8.2 Antithrombotic Medications-Stroke is quite extensive since it includes both anticoagulant medications on Table 8.3 Anticoagulant Medications-Stroke and also antiplatelet medications. Dosages are not used to calculate the measure rates because of increased abstraction burden when conducting chart-based manual review (dosages may be used in eCQM - FYI. The medication tables in Appendix C are tools that facilitate / ease abstraction burden; however, the specific note added to Version 2016A (Discharges 7/1/16 - 12/31/16): STK-5 data element "Antithrombotic Therapy Administered by End of Hospital Day 2" about Lovenox not acceptable for this measure takes precedence over the medication table when abstracting Y/N for this data element.

The purpose of the note is to promote optimal stroke care. There are 4 separate and independent measures in the stroke set which should be met per clinical practice guideline recommendations: VTE-1 VTE Prophylaxis; STK-5 Antithrombotic Therapy Administered by End of Hospital Day 2; STK-2 Antithrombotic Therapy Prescribed at Discharge; and, STK-3 Anticoagulant Therapy for Atrial Fib/Flutter. A single dose of Lovenox on the day of or day after admission is not sufficient antithrombotic therapy for stroke patients. This is stated in the STK-5 rationale, i.e., "Anticoagulants at doses to prevent VTE are insufficient antithrombotic therapy to prevent recurrent stroke or TIA). Stroke patients are to receive Both VTE Prophylaxis (i.e. Lovenox or SQ heparin recommended; SCDs if pharmacological contraindicated) AND antithrombotic therapy (i.e., 325 mg ASA recommended). Credit should not be taken for both measures when both therapies are not administered within the specified timeframes for these measures.

Lovenox is not generally prescribed at discharge for most stroke patients. STK-2 e.g. Plavix, aspirin. STK-3 Coumadin, or a newer DOAC (Xarelto, Pradaxa, Apixaban, Edoxaban). If Lovenox SQ is prescribed at discharge, it will pass both STK-2 and/or STK-3.

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

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Question Details
Focus area(s): Chart Abstracted Measure Specifications – Clinical
Related documents: STK-2, STK-3, STK-5,
Manual: Future Manual (data collection period has not yet started)
File:

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