Specifications Manual for Joint Commission National Quality Measures (v2027A)
Posted: 8/7/2026

Release Notes:
Measure Information Form
Version 2027A

**NQF-ENDORSED VOLUNTARY CONSENSUS STANDARDS FOR HOSPITAL CARE**

Measure Information Form

Measure Set: Stroke (STK)

Set Measure ID: STK-2

Performance Measure Name: Discharged on Antithrombotic Therapy

Description: Ischemic stroke patients prescribed antithrombotic therapy at hospital discharge

Rationale: Many clinical trials have studied the effectiveness of antithrombotic agents in reducing stroke mortality, stroke-related morbidity, and recurrence rates; however, a consequence of antithrombotic therapy administration is the potential risk of intracerebral hemorrhage or clinically significant bleeding. For patients with noncardioembolic ischemic stroke or transient ischemic attack (TIA), clinical guidelines recommend using antiplatelet agents rather than oral anticoagulation to reduce the risk of recurrent stroke and other cardiovascular events unless contraindications exist. (Prabhakaran, S., et al., 2026). Clinicians should individualize the selection of an antiplatelet agent based on patient risk factor profiles, cost, tolerance, relative known efficacy of the agents, and other clinical characteristics (Powers, W., et al., 2019). A recent recommendation from the American Heart/American Stroke Association outlines strong evidence for dual-administration of aspirin and clopidogrel in minor noncardioembolic ischemic stroke (i.e.,, National Institutes of Health Stroke Scale (NIHSS) Score less than or equal to 3) when intravenous thrombolysis is not given. Therapy should be initiated early and continued for 21 days before switching to single anti-platelet therapy (SAPT) long-term, (Prabhakaran, S., et al., 2026).

There are separate guideline recommendations for venous thromboembolism (VTE) prevention after acute ischemic stroke, including extended deep vein thrombosis (DVT) prophylaxis for select patients. (Prabhakaran, S., et al., 2026). Anticoagulants such as enoxaparin and unfractionated heparin (UFH) at doses to prevent DVT are insufficient antithrombotic therapy to prevent recurrent ischemic stroke or TIA.

Type Of Measure: Process

Improvement Noted As: Increase in the rate

Numerator Statement: Ischemic stroke patients prescribed antithrombotic therapy at hospital discharge.
Included Populations: Not applicable

Excluded Populations: None

Data Elements:

Denominator Statement: Ischemic stroke patients.
Included Populations: Discharges with an ICD-10-CM Principal Diagnosis Code for ischemic stroke as defined in Appendix A, Table 8.1.

Excluded Populations:
  • Patients less than 18 years of age
  • Patients who have a Length of Stay greater than 120 days
  • Patients with Comfort Measures Only documented
  • Patients enrolled in clinical trials
  • Patients admitted for Elective Carotid Intervention
  • Patients discharged to another hospital
  • Patients who left against medical advice
  • Patients who expired
  • Patients discharged to home for hospice care
  • Patients discharged to a health care facility for hospice care
  • Patients with a documented Reason For Not Prescribing Antithrombotic Therapy at Discharge

Data Elements:

Risk Adjustment: No.

Data Collection Approach: Retrospective data sources for required data elements include administrative data and medical records. Some hospitals may prefer to gather data concurrently by identifying patients in the population of interest. This approach provides opportunities for improvement at the point of care/service. However, complete documentation includes the principal or other ICD-10 diagnosis and procedure codes, which require retrospective data entry.

Data Accuracy: Variation may exist in the assignment of ICD-10 codes; therefore, coding practices may require evaluation to ensure consistency.

Measure Analysis Suggestions: None

Sampling: Yes. Please refer to the measure set specific sampling requirements and for additional information see the Population and Sampling Specifications section.

Data Reported As: Aggregate rate generated from count data reported as a proportion.

Selected References:
  • Kleindorfer, D. O., Towfighi, A, Chaturvedi, S., Cockroft, K. M., Gutierrez, J., Lombardi-Hill, D., Kamel, H., Kernan, W. N., Kittner, S. J., Leira, E. C., Lennon, O., Meschia, J. F., Nguyen, T. N., Pollak, P. M., Santangeli, P., Sharrief, A. Z., Smith, S. C., Jr., Turan, T. N., & Williams, L. S. (2021). Guideline for the prevention of stroke in patients with stroke and transient ischemic attack: A guideline from the American Heart Association/American Stroke Association. Stroke, 52 (7), e364–e467.
  • Powers, W. J., Rabinstein, A. A., Ackerson, T., Adeoye, O. M., Bambakidis, N. C., Becker, K., Biller, J., et al., on behalf of the American Heart Association Stroke Council. (2018). 2018 guidelines for the early management of patients with acute ischemic stroke: A guideline for healthcare professionals from the American Heart Association/American Stroke Association. Stroke, 49, e10–e11, e26–e30.
  • Powers, W. J., Rabinstein, A. A., Ackerson, T., Adeoye, O. M., Bambakidis, N. C., Becker, K., Biller, J., et al. (2019). Guidelines for the early management of patients with acute ischemic stroke: 2019 update to the 2018 guidelines for the early management of acute ischemic stroke—A guideline for healthcare professionals from the American Heart Association/American Stroke Association. Stroke, 50 (12), e344–e418.
  • Prabhakaran, S., Gonzalez, N. R., Zachrison, K. S., Adeoye, O., Alexandrov, A. W., Ansari, S. A., Chapman, S., Czap, A. L., Dumitrascu, O. M., Ishida, K., Jadhav, A. P., Johnson, B., Johnston, K. C., Khatri, P., Kimberly, W. T., Lee, V. H., Leslie-Mazwi, T. M., Mac Grory, B., Madsen, T. E., Menon, B., Mistry, E. A., Park, S., Parker, S., Pérez de la Ossa, N., Reeves, M., Saiz, T., Scott, P. A., Schwartzberg, D., Sheth, S. A., Sporns, P. B., Times, S., Tjoumakaris, S., Wolfe, S. Q., & Yaghi, S.; Peer Review Committee Collaborators. (2026). 2026 guideline for the early management of patients with acute ischemic stroke: A guideline from the American Heart Association/American Stroke Association. Stroke. Advance online publication. https://doi.org/10.1161/STR.0000000000000513

Measure Algorithm:
Graphic depiction of the Measure Algorithm. Refer to the Algorithm Narrative for each detailed step.

STK-2: Algorithm Narrative

STK-2: Discharged on Antithrombotic Therapy

Numerator: Ischemic stroke patients prescribed antithrombotic therapy at hospital discharge.
Denominator: Ischemic stroke patients.

1. Start Discharged on Antithrombotic Therapy logic. Run cases, which are included in the Stroke Initial Patient Population and pass the edits defined in the Clinical Data Processing Flow, through this measure.

2. Check ICD-10-CM Principial Diagnosis Code.
  1. If none of the ICD-10 CM Principal Diagnosis codes are on Table 8.1, the case will proceed to a Measure Category Assignment of B and will not be In Measure Population. Stop processing.
  2. If ICD-10-CM Principial Diagnosis Code is On Table 8.1, the case will continue processing and proceed to Check Discharge Disposition.
3. Check Discharge Disposition.
  1. If Discharge Disposition is Missing, the case will proceed to a Measure Category Assignment of X and will be rejected. Stop processing.
  2. If Discharge Disposition equals 2, 3, 4, 6, or 7, the case will proceed to a Measure Category Assignment of B and will not be In Measure Population. Stop processing.
  3. If Discharge Disposition equals 1, 5, or 8, the case will continue processing and proceed to Check Comfort Measures Only.
4. Check Comfort Measures Only.
  1. If Comfort Measures Only is Missing, the case will proceed to a Measure Category Assignment of X and will be rejected. Stop processing.
  2. If Comfort Measures Only equals 1, 2, or 3, the case will proceed to a Measure Category Assignment of B and will not be In Measure Population. Stop processing.
  3. If Comfort Measures Only equals 4, the case will continue processing and proceed to Check Clinical Trial.
5. Check Clinical Trial.
  1. If Clinical Trial is Missing, the case will proceed to a Measure Category Assignment of X and will be rejected. Stop processing.
  2. If Clinical Trial equals Y, the case will proceed to a Measure Category Assignment of B and will not be In Measure Population. Stop processing.
  3. If Clinical Trial equals N, the case will continue processing and proceed to Check Elective Carotid Intervention.
6. Check Elective Carotid Intervention.
  1. If Elective Carotid Intervention is Missing, the case will proceed to a Measure Category Assignment of X and will be rejected. Stop processing.
  2. If Elective Carotid Intervention equals Y, the case will proceed to a Measure Category Assignment of B and will not be In Measure Population. Stop processing.
  3. If Elective Carotid Intervention equals N, the case will continue processing and proceed to Check Antithrombotic Therapy Prescribed At Discharge.
7. Check Antithrombotic Therapy Prescribed At Discharge.
  1. If Antithrombotic Therapy Prescribed At Discharge is Missing, the case will proceed to a Measure Category Assignment of X and will be rejected. Stop processing.
  2. If Antithrombotic Therapy Prescribed At Discharge equals Y, the case will proceed to a Measure Category Assignment of E and will be In Numerator Population. Stop processing.
  3. If Antithrombotic Therapy Prescribed At Discharge equals N, the case will continue processing and proceed to Check Reason for Not Prescribing Antithrombotic Therapy at Discharge.
8. Check Reason for Not Prescribing Antithrombotic Therapy at Discharge.
  1. If Reason for Not Prescribing Antithrombotic Therapy at Discharge is Missing, the case will proceed to a Measure Category Assignment of X and will be rejected. Stop processing.
  2. If Reason for Not Prescribing Antithrombotic Therapy at Discharge equals Y, the case will proceed to a Measure Category Assignment of B and will not be In Measure Population. Stop processing.
  3. If Reason for Not Prescribing Antithrombotic Therapy at Discharge equals N, the case will proceed to a Measure Category Assignment of D and will be In Measure Population. Stop processing.

Measure Information Form STK-2
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Specifications Manual for Joint Commission National Quality Measures (v2027A)
Discharges 01-01-2027 (1Q27) through 06-30-2027 (2Q27)

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