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-5

Performance Measure Name: Antithrombotic Therapy By End of Hospital Day Two

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

Rationale: Clinical guidelines from the American Heart Association and American Stroke Association (AHA /ASA) recommend that patients receive antithrombotic or antiplatelet therapy administered within 24 to 48 hours of stroke onset, (Prabhakaran, S., et al., 2026). An unintended negative consequence associated with early antithrombotic therapy administration is the potential risk of intracerebral hemorrhage or clinically significant bleeding, such as a gastrointestinal bleed, (Kernan, W., et al., 2014). Current data suggest that this therapy should be administered within two days of symptom onset in acute ischemic stroke patients to reduce stroke mortality and morbidity as long as no contraindications exist, (Powers, W., et al., 2018). For select patients with minor noncardioembolic ischemic stroke (i.e., National Institutes of Health Stroke Scale (NIHSS) Score less than or equal to 3) who do not receive intravenous thrombolysis, updated 2026 AHA/ASA clinical guidelines suggest both aspirin and clopidogrel are administered within 24 hours of stroke onset, (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 who had antithrombotic therapy administered by end of hospital day 2.
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 Duration of Stay less than 2 days
  • Patients who have a Length of Stay greater than 120 days
  • Patients with Comfort Measures Only documented on day of or day after arrival
  • Patients enrolled in clinical trials
  • Patients admitted for Elective Carotid Intervention
  • Patients discharged prior to the end of hospital day 2
  • Patients with IV OR IA Alteplase Administered at This Hospital or Within 24 Hours Prior to Arrival
  • Patients with a documented Reason for Not Administering Antithrombotic Therapy by End of Hospital Day 2

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:
  • Kernan, W. N., Ovbiagele, B., Black, H. R., Bravata, D. M., Chimowitz, M. I., Ezekowitz, M. D., Fang, M. C., Fisher, M., Furie, K. L., Heck, D. V., Johnston, S. C., Kasner, S. E., Kittner, S. J., Mitchell, P. H., Rich, M. W., Richardson, D., Schwamm, L. H., Wilson, J. A., American Heart Association Stroke Council, Council on Cardiovascular and Stroke Nursing, Council on Clinical Cardiology, & Council on Peripheral Vascular Disease. (2014). Guidelines for the prevention of stroke in patients with stroke and transient ischemic attack: A guideline for healthcare professionals from the American Heart Association/American Stroke Association. Stroke, 45 (7), 2160–2236. http://doi.org/10.1161/STR.0000000000000024
  • 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. Graphic depiction of the Measure Algorithm. Refer to the Algorithm Narrative for each detailed step.

STK-5: Algorithm Narrative

STK-5: Antithrombotic Therapy By End of Hospital Day Two

Numerator: Ischemic stroke patients who had antithrombotic therapy administered by end of hospital day 2.
Denominator: Ischemic stroke patients.

*Variable Key:*
Duration of Stay

1. Start processing. 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 Principal Diagnosis codes
  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 the Measure Population. Stop processing.
  2. If at least one of the ICD-10 CM Principal Diagnosis codes is on Table 8.1, continue processing and proceed to check Comfort Measures Only.

3. 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, the case will proceed to a Measure Category Assignment of B and will not be in the Measure Population. Stop processing.
  3. If Comfort Measures Only equals 2, 3 or 4, continue processing and proceed to check Clinical Trial.

4. 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 the Measure Population. Stop processing.
  3. If Clinical Trial equals N, continue processing and proceed to check Elective Carotid Intervention.

5. Check Elective Carotid Interventions.
  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 the Measure Population. Stop processing.
  3. If Elective Carotid Intervention equals N, continue processing and proceed to check Arrival Date.

6. Check Arrival Date.
  1. If Arrival Date is missing, the case will proceed to a Measure Category Assignment of X and will be rejected. Stop processing.
  2. If Arrival Date equals UTD, the case will proceed to a Measure Category Assignment of D and will be in the Measure Population. Stop processing.
  3. If Arrival Date equals non Unable to Determine (UTD) value, the case will continue processing and proceed to calculation of Duration of Stay.

7. Calculate the Duration of stay.
  1. Duration of Stay (in days) equals Discharge Date minus Arrival Date.
  2. Proceed to check Duration of Stay.

8. Check Duration of Stay.
  1. If Duration of Stay is greater than or equal to 0 and less than 2 Days, the case will proceed to a Measure Category Assignment of B and will not be in the measure population. Stop processing.
  2. If Duration of Stay is greater than or equal to 2, the case will continue processing and proceed to check IV OR IA Alteplase Therapy Administered at This Hospital or Within 24 Hours Prior to Arrival.

9. Check IV OR IA Alteplase Therapy Administered at This Hospital or Within 24 Hours Prior to Arrival.
  1. If IV OR IA Alteplase Therapy Administered at This Hospital or Within 24 Hours Prior to Arrival is missing, the case will proceed to a Measure Category Assignment of X and will be rejected. Stop processing.
  2. If IV OR IA Alteplase Therapy Administered at This Hospital or Within 24 Hours Prior to Arrival equals Y, the case will proceed to a Measure Category Assignment of B and will not be in the Measure Population. Stop processing.
  3. If IV OR IA Alteplase Therapy Administered at This Hospital or Within 24 Hours Prior to Arrival equals N, continue processing and proceed to check Antithrombotic Therapy Administered by End of Hospital Day 2.

10. Check Antithrombotic Therapy Administered by End of Hospital Day 2.

  1. If Antithrombotic Therapy Administered by End of Hospital Day 2 is missing, the case will proceed to a Measure Category Assignment of X and will be rejected. Stop processing.
  2. If Antithrombotic Therapy Administered by End of Hospital Day 2 equals Y, the case will proceed to a Measure Category Assignment of E and will be in the Numerator Population. Stop processing.
  3. If Antithrombotic Therapy Administered by End of Hospital Day 2 equals N, continue processing and proceed to check Reason for Not Administering Antithrombotic Therapy by End of Hospital Day 2.

11. Check Reason for Not Administering Antithrombotic Therapy by End of Hospital Day 2.

  1. If Reason for Not Administering Antithrombotic Therapy by End of Hospital Day 2 is missing, the case will proceed to a Measure Category Assignment of X and will be rejected. Stop processing.
  2. If Reason for Not Administering Antithrombotic Therapy by End of Hospital Day 2 equals Y, the case will proceed to a Measure Category Assignment of B and will not be in the measure population. Stop processing.
  3. If Reason for Not Administering Antithrombotic Therapy by End of Hospital Day 2 equals N, the case will proceed to a Measure Category Assignment of D and will be in the Measure Population. Stop processing.

Measure Information Form STK-5
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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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