Prescribed at discharge: Documentation that patient/caregiver was given a prescription for antithrombotic therapy at time of hospital discharge.

Reasons for not prescribing antithrombotic therapy must be documented by a physician, nurse practitioner or physician assistant. If reasons are not mentioned in the context of antithrombotics, do not make inferences (e.g., do not assume that antrithombotics are not being prescribed because of a bleeding disorder unless documentation explicitly states so.)

Conditions or factors making the administration of antithrombotic therapy inadvisable, inappropriate and/or undesirable are documented (appropriate response is “NC”, documented reason for not prescribing antithrombotic) This may include:

• Allergy to or complication r/t antithrombotic (hx/current)
• Aortic dissection (current)
• Bleeding disorder
• Brain/CNS cancer (hx/current)
• CVA, hemorrhagic (hx/current)
• Extensive/metastatic CA (hx/current)
• Hemorrhage, any type (hx/current)
• Intracranial surgery/biopsy (current)
• Patient refusal
• Peptic ulcer (current)
• Planned surgery within 7 days following discharge
• Risk of bleeding (current)
• Unrepaired intracranial aneurysm (hx/current)
• Other (patient/physician)

• Progress notes
• Physician orders
• Discharge summary
• Medication record
• Clinical logs
• Discharge instructions