Performance Measurement Network

Question: Antithrombotic Administration after t-PA

If a patient receives t-PA at 2000 on hospital day 1 and the infusion is completed by 2100, do we need to administer ASA by 2100 on hospital day 2 in order to meet STK-5: Antithrombotic Therapy Administered By End of Hospital Day 2? Physician orders are for ASA QD, which would normally be given at 0900 on hopsital day 2; however, antithrombotic therapy is contraindicated for 24 hrs following t-PA administration.

Answer:

The data element definition for "IV OR IA Thrombolytic Therapy Administered at This Hospital or Within 24 Hours Prior to Arrival" states to select "Yes" if patient received IV or IA t-PA at *this hospital*. The 24 hour timeframe applies only to t-PA administration given at another hospital.

In other words, if a transferring hospital gave t-PA 2 or 3 days prior to transfer to your hospital, your hospital could not exclude the case and should give ASA/antithrombotic by end of hospital day 2. If a transerring hospital administered t-PA 24 hrs prior to arrival at your hospital, you may exclude the case. Likewise, you may exclude the case if your hopsital administers t-PA.

If you give ASA at 2100 on hospital day 2, it will not be included in the numerator because you already excluded the case by selecting "Yes" for "IV OR IA Thrombolytic Administered at This Hospital of Within 24 Hours Prior to Arrival" (see STK-4 algorithm - the "IV or IA" decision comes before "Antithrombotic Administered" in the flow logic).

Question Details
Focus area(s): Chart Abstracted Measure Specifications – Clinical
Related documents: STK-05,
File:

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