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  1. eCQM Issue Tracker
  2. CQM-5740

eCQM STK-5 Heparin Dosage 5000 units sq Not on Antithrombotic Therapy value set

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    • Icon: EH/CAH eCQMs EH/CAH eCQMs
    • Resolution: Answered
    • Icon: Moderate Moderate
    • None
    • None
    • Mary Mallow
    • 443-492-9114
    • Adventist Healthcare
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      Thank you for your feedback. When patients qualify for STK-5, they may have a variety of preexisting conditions and medicines that they are already taking (i.e. Afib may already be taking anticoagulants). All stroke patients are supposed to get Antithrombotic Therapy by end of day 2 unless one of the valid exclusions apply.

        

      Antithrombotic Therapy” value set oid: 2.16.840.1.113762.1.4.1110.62 groups two value sets;

      - “Antithrombotic Therapy Anticoagulant”, oid: 2.16.840.1.113883.3.117.1.7.1.201
      - “Antithrombotic Therapy Antiplatelet”, oid:
      2.16.840.1.113762.1.4.1110.61
       

      It is important to consider the intent and purpose of the value set:

       

      Clinical Focus:

      The purpose of this value set is to represent concepts of medications that are antiplatelet medications used to reduce stroke mortality and morbidity.

       

      Inclusion Criteria:

      Includes concepts that represent a medication that is an antithrombotic medication, including oral, rectal, and injectable dose forms.

       

      Exclusion Criteria:

      Excludes concepts that represent enoxaparin and heparin generally given for VTE prophylaxis.

       

      These value sets are reviewed and updated annually. I hope this answers your question. Please let us know if you have any other questions or concerns.
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      Thank you for your feedback. When patients qualify for STK-5, they may have a variety of preexisting conditions and medicines that they are already taking (i.e. Afib may already be taking anticoagulants). All stroke patients are supposed to get Antithrombotic Therapy by end of day 2 unless one of the valid exclusions apply.    Antithrombotic Therapy” value set oid: 2.16.840.1.113762.1.4.1110.62 groups two value sets; - “Antithrombotic Therapy Anticoagulant”, oid: 2.16.840.1.113883.3.117.1.7.1.201 - “Antithrombotic Therapy Antiplatelet”, oid: 2.16.840.1.113762.1.4.1110.61   It is important to consider the intent and purpose of the value set:   Clinical Focus: The purpose of this value set is to represent concepts of medications that are antiplatelet medications used to reduce stroke mortality and morbidity.   Inclusion Criteria: Includes concepts that represent a medication that is an antithrombotic medication, including oral, rectal, and injectable dose forms.   Exclusion Criteria: Excludes concepts that represent enoxaparin and heparin generally given for VTE prophylaxis.   These value sets are reviewed and updated annually. I hope this answers your question. Please let us know if you have any other questions or concerns.
    • CMS0072v11
    • CMS0072v10
    • Limiting the value set to high dose heparin conflicts with the current ischemic stroke guidelines.

      Antithrombotic Therapy value set 2.16.840.1.113762.1.4.1110.62

      High dosage heparin on the current value set is not supported by American Heart and American Stroke Association 2019 Guidelines for the Early management of patients with acute ischemic stroke Section 3.10.Anticoagulants #5 that states that urgent anticoagulation, with the goal of preventing early recurrent stroke, halting neurological worsening, or improving outcomes after acute ischemic stroke, is not recommended for treatment of patients with acute ischemic stroke. Class of recommendation III, Level of Evidence A
      This also conflicts with that fact that Aspirin 81 mg is included in the antithrombotic value set, but aspirin is not effective as an anticoagulant. Patients with atrial fibrillation only represent a fraction of the stroke population. We understand VTE dosing and antithrombotic dosing to be two distinct therapeutic categories. Aspirin would not be considered VTE prophylaxis, but serves as antithrombotic therapy for ischemic stroke patients according eCQM STK-5 guidelines.

       

        1. STR.0000000000000211.pdf
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            JLeflore Mathematica EH eCQM Team
            esolomon Emily Solomon
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