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Antithrombotic Therapy by End of Hospital Day 2

Measure Information
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Table Options
Measure Information 2023 Reporting Period 2024 Reporting Period 2025 Reporting Period 2026 Reporting Period
Title Antithrombotic Therapy By End of Hospital Day 2 Antithrombotic Therapy By End of Hospital Day 2 Antithrombotic Therapy by End of Hospital Day 2 Antithrombotic Therapy by End of Hospital Day 2
CMS eCQM ID CMS72v11 CMS72v12 CMS72v13 CMS72v14
Short Name

STK-5

STK-5

STK-5

STK-5

CBE ID* Not Applicable Not Applicable Not Applicable Not Applicable
Measure Steward The Joint Commission The Joint Commission The Joint Commission The Joint Commission
Description

Ischemic stroke patients administered antithrombotic therapy by the end of hospital day 2

Ischemic stroke patients administered antithrombotic therapy by the end of hospital day 2

Ischemic stroke patients administered antithrombotic therapy by the end of hospital day 2

Ischemic stroke patients administered antithrombotic therapy by the end of hospital day 2

Measure Scoring Proportion measure Proportion measure Proportion measure Proportion measure
Measure Type Process Process Process Process
Stratification *See CMS72v11.html

None

None

None

Risk Adjustment *See CMS72v11.html

None

None

None

Rationale *See CMS72v11.html

The effectiveness of antithrombotic agents in reducing stroke mortality, stroke-related morbidity and recurrence rates has been studied in several large clinical trials. While the use of these agents for patients with acute ischemic stroke and transient ischemic attacks (TIA) continues to be the subject of study, substantial evidence is available from completed studies. Data at this time suggest that antithrombotic therapy should be administered within 2 days of symptom onset in acute ischemic stroke patients to reduce stroke mortality and morbidity as long as no contraindications exist.

Aspirin is the recommended antithrombotic medication for early antithrombotic therapy and most frequently administered unless contraindicated. Anticoagulants at doses to prevent venous thromboembolism (VTE) are insufficient. Subcutaneous lovenox (enoxaparin) and unfractionated heparin (UFH) SQ at lower dosages used for VTE prophylaxis (i.e., enoxaparin SQ 40 mg once daily; enoxaparin SQ 30 mg Q12 hours; UFH 5,000 units or less two or three times daily) are not sufficient for early antithrombotic therapy.

Anticoagulants at doses to prevent VTE are insufficient antithrombotic therapy to prevent recurrent ischemic stroke or TIA.

The effectiveness of antithrombotic agents in reducing stroke mortality, stroke-related morbidity and recurrence rates has been studied in several large clinical trials. While the use of these agents for patients with acute ischemic stroke and transient ischemic attacks (TIA) continues to be the subject of study, substantial evidence is available from completed studies. Data at this time suggest that antithrombotic therapy should be administered within 2 days of symptom onset in acute ischemic stroke patients to reduce stroke mortality and morbidity if no contraindications exist.

Aspirin is the recommended antithrombotic medication for early antithrombotic therapy and most frequently administered unless contraindicated. Anticoagulants at doses to prevent venous thromboembolism (VTE) are insufficient. Subcutaneous Lovenox (enoxaparin) and unfractionated heparin (UFH) SQ at lower dosages used for VTE prophylaxis (i.e., enoxaparin SQ 40 mg once daily; enoxaparin SQ 30 mg Q12 hours; UFH 5,000 units or less two or three times daily) are not sufficient for early antithrombotic therapy.

Anticoagulants at doses to prevent VTE are insufficient antithrombotic therapy to prevent recurrent ischemic stroke or TIA.

The effectiveness of antithrombotic agents in reducing stroke mortality, stroke-related morbidity and recurrence rates has been studied in several large clinical trials. While the use of these agents for patients with acute ischemic stroke and transient ischemic attacks (TIA) continues to be the subject of study, substantial evidence is available from completed studies. Data at this time suggest that antithrombotic therapy should be administered within 2 days of symptom onset in acute ischemic stroke patients to reduce stroke mortality and morbidity if no contraindications exist.

Aspirin is the recommended antithrombotic medication for early antithrombotic therapy and most frequently administered unless contraindicated. Anticoagulants at doses to prevent venous thromboembolism (VTE) are insufficient. Subcutaneous Lovenox (enoxaparin) and unfractionated heparin (UFH) SQ at lower dosages used for VTE prophylaxis (i.e., enoxaparin SQ 40 mg once daily; enoxaparin SQ 30 mg Q12 hours; UFH 5,000 units or less two or three times daily) are not sufficient for early antithrombotic therapy.

Anticoagulants at doses to prevent VTE are insufficient antithrombotic therapy to prevent recurrent ischemic stroke or TIA.

Clinical Recommendation Statement *See CMS72v11.html

Antithrombotic therapy should be administered within 2 days of symptom onset in acute ischemic stroke patients to reduce stroke mortality and morbidity as long as no contraindications exist

Antithrombotic therapy should be administered within 2 days of symptom onset in acute ischemic stroke patients to reduce stroke mortality and morbidity if no contraindications exist

Antithrombotic therapy should be administered within 2 days of symptom onset in acute ischemic stroke patients to reduce stroke mortality and morbidity if no contraindications exist

Improvement Notation

Improvement noted as an increase in rate

Improvement noted as an increase in rate

Improvement noted as an increase in rate

Increased score indicates improvement

Definition *See CMS72v11.html

None

None

None

Guidance

The "Non-elective Inpatient Encounter" value set intends to capture all non-scheduled hospitalizations. This value set is a subset of the "Inpatient Encounter" value set, excluding concepts that specifically refer to elective hospital admissions. Non-elective Inpatient Encounters include emergency, urgent, and unplanned admissions.

NPO (Nothing by mouth) is not a valid reason for not administering antithrombotic therapy by end of hospital day 2 as another route of administration can be used (i.e. rectal or intravenous).

In the denominator exclusions, the intent is to only exclude patients with a total length of stay of <2 days, including ED visit (if there is one). For the eCQM we model both of the scenarios of admission via the ED as well as direct admits. This statement addresses direct admits.

The denominator population includes patients with inpatient hospitalizations and patients from Acute Hospital Care at Home programs, who are treated and billed as inpatients but receive care in their home.

This eCQM is an episode-based measure. An episode is defined as each inpatient hospitalization or encounter that ends during the measurement period.

This version of the eCQM uses QDM version 5.6. Please refer to the QDM page for more information on the QDM.

The "Nonelective Inpatient Encounter" value set intends to capture all non-scheduled hospitalizations. This value set is a subset of the "Inpatient Encounter" value set, excluding concepts that specifically refer to elective hospital admissions. Non-elective Inpatient Encounters include emergency, urgent, and unplanned admissions.

NPO (Nothing by mouth) is not a valid reason for not administering antithrombotic therapy by end of hospital day 2 as another route of administration can be used (i.e., rectal or intravenous).

In the denominator exclusions, the intent is to only exclude patients with a total length of stay of <2 days, including ED visit (if there is one). For the eCQM we model both of the scenarios of admission via the ED as well as direct admits. This statement addresses direct admits.

The denominator population includes patients with inpatient hospitalizations and patients from Acute Hospital Care at Home programs, who are treated and billed as inpatients but receive care in their home.

This eCQM is an episode-based measure. An episode is defined as each inpatient hospitalization or encounter that ends during the measurement period.

This version of the eCQM uses QDM version 5.6. Please refer to the QDM page for more information on the QDM.

The "Nonelective Inpatient Encounter" value set intends to capture all non-scheduled hospitalizations. This value set is a subset of the "Inpatient Encounter" value set, excluding concepts that specifically refer to elective hospital admissions. Non-elective Inpatient Encounters include emergency, urgent, and unplanned admissions.

NPO (Nothing by mouth) is not a valid reason for not administering antithrombotic therapy by end of hospital day 2 as another route of administration can be used (i.e., rectal or intravenous).

In the denominator exclusions, the intent is to only exclude patients with a total length of stay of <2 days, including emergency department (ED) visit (if there is one). For the eCQM we model both of the scenarios of admission via the ED as well as direct admits. This statement addresses direct admits.

The denominator population includes patients with inpatient hospitalizations and patients from Acute Hospital Care at Home programs, who are treated and billed as inpatients but receive care in their home.

This eCQM is an episode-based measure. An episode is defined as each inpatient hospitalization or encounter that ends during the measurement period.

This version of the eCQM uses QDM version 5.6. Please refer to the QDM page for more information on the QDM.

The "Nonelective Inpatient Encounter" value set intends to capture all non-scheduled hospitalizations. This value set is a subset of the "Inpatient Encounter" value set, excluding concepts that specifically refer to elective hospital admissions. Non-elective Inpatient Encounters include emergency, urgent, and unplanned admissions.

NPO (Nothing by mouth) is not a valid reason for not administering antithrombotic therapy by end of hospital day 2 as another route of administration can be used (i.e., rectal or intravenous).

In the denominator exclusions, the intent is to only exclude patients with a total length of stay of <2 days, including emergency department (ED) visit (if there is one). For the eCQM we model both of the scenarios of admission via the ED as well as direct admits. This statement addresses direct admits.

The denominator population includes patients with inpatient hospitalizations and patients from Acute Hospital Care at Home programs, who are treated and billed as inpatients but receive care in their home.

This eCQM is an episode-based measure. An episode is defined as each inpatient hospitalization or encounter that ends during the measurement period.

This version of the eCQM uses QDM version 5.6. Please refer to the QDM page for more information on the QDM.

Initial Population

Inpatient hospitalization for patients age 18 and older discharged from inpatient care (non-elective admissions) with a principal diagnosis of ischemic or hemorrhagic stroke and a length of stay less than or equal to 120 days that ends during measurement period

Inpatient hospitalization for patients age 18 and older discharged from inpatient care (non-elective admissions) with a principal diagnosis of ischemic or hemorrhagic stroke and a length of stay less than or equal to 120 days that ends during measurement period

Inpatient hospitalizations (non-elective admissions) for patients age 18 and older, discharged from inpatient care with a principal diagnosis of ischemic stroke, ending during the measurement period

Inpatient hospitalizations (non-elective admissions) for patients age 18 and older, discharged from inpatient care with a principal diagnosis of ischemic stroke, ending during the measurement period

Denominator

Inpatient hospitalizations for patients with a principal diagnosis of ischemic stroke

Inpatient hospitalizations for patients with a principal diagnosis of ischemic stroke

Equals Initial Population

Equals Initial Population

Denominator Exclusions

* Inpatient hospitalizations for patients who have a duration of stay less than 2 days

* Inpatient hospitalization for patients with comfort measures documented day of or the day after arrival

* Inpatient hospitalization for patients with intra-venous or intra-arterial Thrombolytic (t-PA) Therapy administered within 24 hours prior to arrival or anytime during hospitalization

- Inpatient hospitalizations for patients who have a duration of stay less than 2 days

- Inpatient hospitalization for patients with comfort measures documented day of or the day after arrival

- Inpatient hospitalization for patients with intra-venous or intra-arterial Thrombolytic (t-PA) Therapy administered within 24 hours prior to arrival or anytime during hospitalization

- Inpatient hospitalization for patients who have a duration of stay less than 2 days

- Inpatient hospitalization for patients with comfort measures documented day of or the day after arrival

- Inpatient hospitalization for patients with intra-venous or intra-arterial Thrombolytic (t-PA) Therapy

administered within 24 hours prior to arrival or anytime during hospitalization

- Inpatient hospitalizations for patients who have a duration of stay less than 2 days

- Inpatient hospitalizations for patients with comfort measures documented day of or the day after arrival

- Inpatient hospitalizations for patients with intra-venous or intra-arterial Thrombolytic (t-PA) Therapy

administered within 24 hours prior to arrival or anytime during hospitalization

Numerator

Inpatient hospitalization for patients who had antithrombotic therapy administered the day of or day after hospital arrival

Inpatient hospitalization for patients who had antithrombotic therapy administered the day of or day after hospital arrival

Inpatient hospitalization for patients who had antithrombotic therapy administered the day of or day after hospital arrival

Inpatient hospitalizations for patients who had antithrombotic therapy administered the day of or day after hospital arrival

Numerator Exclusions

Not Applicable

Not Applicable

Not Applicable

None

Denominator Exceptions

* Inpatient hospitalization for patients with a documented reason for not administering antithrombotic therapy the day of or day after hospital arrival

* Inpatient hospitalization for patients who receive Prasugrel as an antithrombotic therapy the day of or day after hospital arrival

* Inpatient hospitalization for patients with an INR greater than 3.5

- Inpatient hospitalization for patients with a documented reason for not administering antithrombotic therapy the day of or day after hospital arrival

- Inpatient hospitalization for patients who receive Prasugrel as an antithrombotic therapy the day of or day after hospital arrival

- Inpatient hospitalization for patients with an INR greater than 3.5

- Inpatient hospitalization for patients with a documented reason for not administering antithrombotic therapy the day of or day after hospital arrival.

- Inpatient hospitalization for patients who receive Prasugrel as an antithrombotic therapy the day of or day after hospital arrival.

- Inpatient hospitalization for patients with an international normalized ratio (INR) greater than 3.5.

- Inpatient hospitalizations for patients with a documented reason for not administering antithrombotic therapy the day of or day after hospital arrival.

- Inpatient hospitalizations for patients who receive Prasugrel as an antithrombotic therapy the day of or day after hospital arrival.

- Inpatient hospitalizations for patients with an international normalized ratio (INR) greater than 3.5.

Next Version No Version Available
Previous Version No Version Available
Specifications and Data Elements
General eCQM Information
Release Notes
General eCQM Information

Header

TRN

Measure Section

Source of Change

Updated 'eCQM Identifier (Measure Authoring Tool)' field to 'CMS ID' based on tooling update.

CMS ID

Standards/Technical Update

Updated the eCQM version number.

eCQM Version Number

Annual Update

Updated measurement period to reflect exact dates of reporting.

Measurement Period

Standards/Technical Update

Updated copyright.

Copyright

Annual Update

Updated disclaimer.

Disclaimer

Annual Update

Updated Improvement Notation field to read 'Increased score indicates improvement' based on tooling update to promote alignment across measures.

Improvement Notation

Standards/Technical Update

Updated Numerator Exclusions field to read 'None' instead of 'Not Applicable' when no exclusions present to promote alignment across header fields.

Numerator Exclusions

Standards/Technical Update

Updated references and measure header to reflect current evidence and new or updated literature.

Multiple Sections

Measure Lead

Updated grammar, wording, and/or formatting to improve readability and consistency.

Multiple Sections

Annual Update

Logic

TRN

Measure Section

Source of Change

Updated the CQL library name from 'CMS72-v13-0-000-QDM-5-6.cql' to 'CMS72STKAntithromboticDay2-14.2.000.cql' based on recommendation by technical experts.

Definitions

Standards/Technical Update

Updated the names of CQL definitions, functions, and/or aliases for clarification and to align with the CQL Style Guide.

Definitions

Standards/Technical Update

Updated the version number of the Global Shared Library to v9.0.000 and the library name from 'MATGlobalCommonFunctionsQDM' to 'CQMCommonQDM'.

Definitions

Annual Update

Updated the version number of the TJC Overall Library to v9.0.000.

Definitions

Annual Update

Updated the version number of the Global Shared Library to v9.0.000 and the library name from 'MATGlobalCommonFunctionsQDM' to 'CQMCommonQDM'.

Functions

Annual Update

Updated the version number of the TJC Overall Library to v9.0.000.

Functions

Annual Update

Value Set

The VSAC is the source of truth for the value set content, please visit the VSAC for downloads of current value sets.

TRN

Measure Section

Source of Change

Replaced value set used for Sex Supplemental Data Element (SDE) ONC Administrative Sex (2.16.840.1.113762.1.4.1) with value set Federal Administrative Sex (2.16.840.1.113762.1.4.1021.121) based on updated standards.

Terminology

Standards/Technical Update

Value set Antithrombotic Therapy for Ischemic Stroke (2.16.840.1.113762.1.4.1110.62): Added 2 RxNorm codes (197945, 2626726) based on terminology update. Deleted 1 RxNorm code (1361615) based on review by technical experts, SMEs, and/or public feedback. Deleted 1 RxNorm code (198473) based on terminology update.

Terminology

Measure Lead

Value set Nonelective Inpatient Encounter (2.16.840.1.113883.3.117.1.7.1.424): Added 1 SNOMED CT code (442281000124108) based on terminology update.

Terminology

Annual Update

Value set Patient Refusal (2.16.840.1.113883.3.117.1.7.1.93): Added 1 SNOMED CT code (1296859006) based on terminology update. Deleted 1 SNOMED CT code (105480006) based on terminology update.

Terminology

Annual Update

Last Updated: May 07, 2025