Specifications Manual for Joint Commission National Quality Measures (v2023A)
Posted: 08/12/2022
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Appendix HTJC
Version 2023A

Appendix H

Miscellaneous Tables

Table 2.1 VTE Prophylaxis Inclusion Table

VTE Prophylaxis Inclusion/Synonyms
Coumadin/Warfarin Coumadin
Warfarin Sodium
Graduated Compression Stockings (GCS)
-Knee or Thigh High
Anti-Embolism stockings
Anti-thrombosis stockings
Elastic support hose
Graduated compression elastic stockings
Surgical hose
White hose
Thrombosis stockings
Factor Xa Inhibitor Arixtra
Fondaparinux sodium
Oral Factor Xa Inhibitor Apixaban1
Low Dose Unfractionated Heparin (LDUH)
- Include only Heparin given by the subcutaneous (SQ, Subcu, SC, SubQ) route
Heparin Na
Heparin Sod
Heparin Sodium
Heparin Sodium Inj.
Heparin Sodium Inj. Pork
Heparin Subcu/SQ/SC/SubQ
Low Molecular Weight Heparin (LMWH) Dalteparin
Intermittent Pneumatic Compression Device (IPC) AE pumps (anti-embolic pumps)-calf/thigh
DVT boots-calf/thigh
EPC cuffs/ stockings-External pneumatic compression-calf/thigh
Intermittent pneumatic compression stockings
Intermittent compression device (ICD)
Leg pumpers
Pneumatic intermittent impulse compression device
Rapid inflation asymmetrical compression (RIAC) devices
Sequential compression device
Sequential pneumatic hose
Thrombus pumps-calf/thigh
Venous Foot Pump (VFP) AE pumps-foot only
Foot pump
Plantar venous plexus pump-foot only
SC boots-foot only
SCD boots-foot only
Venous foot pump
Note: This table is not meant to be an inclusive list of all available prophylaxis; rather it represents current information available at the time of publication.

1 The U.S. Food and Drug Administration (FDA) has approved Eliquis (apixaban) to reduce the risk of stroke and systemic embolism in patients with non-valvular atrial fibrillation or to reduce the risk of blood clots, deep vein thrombosis (DVT) and pulmonary embolism (PE) following knee or hip replacement surgery only. It is additionally approved for treatment of DVT and PE and for the reduction in the risk of recurrent DVT and PE following initial therapy.
2 The U.S. Food and Drug Administration has approved Xarelto (rivaroxaban) for the prevention of venous thromboembolism (VTE) in hospitalized acutely ill medical patients at risk for thromboembolic complications who are not at high risk of bleeding. It is additionally approved: to reduce the risk of deep vein thrombosis (DVT) and pulmonary embolism (PE) following knee or hip replacement surgery; to reduce the risk of stroke in patients with non-valvular atrial fibrillation; for treatment of DVT or PE; to reduce the risk of recurrent DVT and PE following initial treatment.
3 The FDA approved edoxaban (Savaysa) to reduce the risk of stroke and dangerous blood clots (systemic embolism) in patients with atrial fibrillation that is not caused by a heart valve problem. Savaysa has been approved to treat deep vein thrombosis (DVT) and pulmonary embolism (PE) in patients who have already been treated with anti-clotting drug administered by injection or infusion (parenterally), for five to ten days.

Table 2.7 Anticoagulation Therapy Table

Anticoagulation Therapy – All Inclusive Inclusion/Synonyms
Direct Thrombin Inhibitors Acova
Dabigatran etexilate
Recombinant Hirudin
Glycoprotein IIb/IIIa Inhibitor: Abciximab

Appendix HTJC
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Specifications Manual for Joint Commission National Quality Measures (v2023A)
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