Antithrombotic Therapy By End of Hospital Day 2

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

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This material contains SNOMED Clinical Terms(R) (SNOMED CT(C)) copyright 2004-2016 International Health Terminology Standards Development Organization. All rights reserved.

These performance measures are not clinical guidelines and do not establish a standard of medical care, and have not been tested for all potential applications. The measures and specifications are provided without warranty.

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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 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.

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

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

Improvement noted as an increase in rate

Antithrombotic Trialists, Collaboration. "Collaborative Meta-Analysis of Randomised Trials of Antiplatelet Therapy for Prevention of Death, Myocardial Infarction, and Stroke in High Risk Patients." [In eng]. BMJ 324, no. 7329 (Jan 12 2002): 71-86.

Chen, Z. M., P. Sandercock, H. C. Pan, C. Counsell, R. Collins, L. S. Liu, J. X. Xie, C. Warlow, and R. Peto. "Indications for Early Aspirin Use in Acute Ischemic Stroke : A Combined Analysis of 40 000 Randomized Patients from the Chinese Acute Stroke Trial and the International Stroke Trial. On Behalf of the Chinese Acute Stroke Trial and International Stroke Trial Collaborative Groups." [In eng]. Stroke 31, no. 6 (Jun 2000): 1240-9.

Coull, B. M., L. S. Williams, L. B. Goldstein, J. F. Meschia, D. Heitzman, S. Chaturvedi, K. C. Johnston, et al. "Anticoagulants and Antiplatelet Agents in Acute Ischemic Stroke: Report of the Joint Stroke Guideline Development Committee of the American Academy of Neurology and the American Stroke Association (a Division of the American Heart Association)." [In eng]. Stroke 33, no. 7 (Jul 2002): 1934-42.

Furie, K. L., S. E. Kasner, R. J. Adams, G. W. Albers, R. L. Bush, S. C. Fagan, J. L. Halperin, et al. "Guidelines for the Prevention of Stroke in Patients with Stroke or Transient Ischemic Attack: A Guideline for Healthcare Professionals from the American Heart Association/American Stroke Association." [In eng]. Stroke 42, no. 1 (Jan 2011): 227-76.

Guyatt, G. H., E. A. Akl, M. Crowther, D. D. Gutterman, H. J. Schuunemann, Therapy American College of Chest Physicians Antithrombotic, and Panel Prevention of Thrombosis. "Executive Summary: Antithrombotic Therapy and Prevention of Thrombosis, 9th Ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines." [In eng]. Chest 141, no. 2 Suppl (Feb 2012): 7S-47S.

Jauch, E. C., J. L. Saver, H. P. Adams, Jr., A. Bruno, J. J. Connors, B. M. Demaerschalk, P. Khatri, et al. "Guidelines for the Early Management of Patients with Acute Ischemic Stroke: A Guideline for Healthcare Professionals from the American Heart Association/American Stroke Association." [In Eng]. Stroke  (Jan 31 2013).

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The "Non-elective admissions" 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 admissions include emergency, urgent and unplanned admissions.

NPO 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.

TBD

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

Patients with a principal diagnosis of Ischemic stroke

Patients who have a duration of stay less than 2 days

Patients with comfort measures documented on day or the day after arrival

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

Patients who had antithrombotic therapy administered the day of or day after hospital arrival

Not Applicable

Patients with a documented reason for not administering antithrombotic therapy the day of or day after hospital arrival

For every patient evaluated by this measure also identify payer, race, ethnicity and sex

eMeasure Stroke (eSTK)