The document discusses 6 VTE (venous thromboembolism) core measures relating to the prevention and treatment of DVT and PE in hospitalized patients. Core Measure 1 assesses providing VTE prophylaxis to high-risk patients. Core Measure 2 focuses on prophylaxis for ICU patients, who are at increased risk due to limited mobility. Core Measure 3 concerns giving overlap therapy of parenteral and oral anticoagulants for acute VTE. Core Measure 4 involves monitoring platelet counts during heparin therapy to prevent heparin-induced thrombocytopenia. Core Measure 5 addresses discharging VTE patients with instructions on warfarin compliance and follow-up. Core Measure 6 looks at whether hospitalized

1. VTE Core Measures
A quick look at the 6 VTE core measures

2. VTE Core Measure 1
This measure assesses the number of patients who received VTE
prophylaxis or have documentation why no VTE prophylaxis was
given the day of or the day after hospital admission or surgery
end date for surgeries that start the day of or the day after
hospital admission.

3. Reason for Core Measure 1
High-risk patients in hospitals may develop DVT and die form PE
before the diagnosis is suspected. Since sudden or abrupt death
are common for PE, the importance of prevention is highlighted
here.

4. VTE Core Measure 2
This measure assesses the number of patients who received VTE
prophylaxis or have documentation why no VTE prophylaxis was
given the day of or the day after the initial admission (or transfer)
to the Intensive Care Unit (ICU) or surgery end date for surgeries
that start the day of or the day after ICU admission (or transfer)

5. Reason for Core Measure 2
It is common that the criteria itself for admission to the ICU puts
patients at an increased risk for developing VTE. This leads to an
increased risk for morbidity from PE. Some examples of criteria
for admission to the ICU that increase risk are limitations of
mobility, presence of central venous lines or mechanical
ventilation and subsequent pharmacological paralysis.

6. VTE Core Measure 3
This measure assesses the number of patients diagnosed with
confirmed VTE who received an overlap of parenteral (intravenous
[IV] or subcutaneous [subcu]) anticoagulation and warfarin
therapy. For patients who received less than five days of overlap
therapy, they should be discharged on both medications or have
a Reason for Discontinuation of Parenteral Anticoagulation
Therapy. Overlap therapy should be administered for at least five
days with an international normalized ratio (INR) greater than or
equal to 2 prior to discontinuation of the parenteral
anticoagulation therapy, discharged on both medications or have
a Reason for Discontinuation of Parenteral Anticoagulation
Therapy.

7. Reason for Core Measure 3
Warfarin has a very slow onset of action and it cannot be used as
mono-therapy for acute VTE. Parenteral anticoagulation is the
first line of therapy because it has a rapid onset. Therefore, the
Overlap Therapy is necessary.

8. VTE Core Measure 4
This measure assesses the number of patients diagnosed with
confirmed VTE who received intravenous (IV) UFH therapy
dosages AND had their platelet counts monitored using defined
parameters such as a nomogram or protocol.

9. Reason for Core Measure 4
Heparin prophylaxis is connected to adverse drug events like
major bleeding. Platelet count monitoring allows for prompt
recognition of Heparin-Induced Thrombocytopenia. The
discontinuation of Heparin results in the risk of venous and
arterial thrombosis decreasing.

10. VTE Core Measure 5
This measure assesses the number of patients diagnosed with
confirmed VTE that are discharged to home, home care, court/law
enforcement or home on hospice care on warfarin with written
discharge instructions that address all four criteria: compliance
issues, dietary advice, follow-up monitoring, and information
about the potential for adverse drug reactions/interactions.

11. Reason for Core Measure 5
Patient education is a vital component when attempting to
achieve successful outcomes and reduce hospital readmission
rates. Patients benefit from the education of the potential
consequences from their disease and its treatment. Also, due to
complex dosing of anticoagulants and inconsistent patient
compliance, the follow-up monitoring is necessary.

12. VTE Core Measures 6
This measure assesses the number of patients diagnosed with
confirmed VTE during hospitalization (not present at admission)
who did not receive VTE prophylaxis between hospital admission
and the day before the VTE diagnostic testing order date.

13. Reason for Core Measure 6
The incidence of preventable VTE among hospitalized patients is
too high. Even with the research done and guidelines in place
there are too many occurrences of VTE where the patient did not
receive prophylaxis.

14. Interested in Learning More?
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