In the United States, a high-dose aspirin for thromboprophylaxis is usually a 162 mg or a 325-mg regimen. Denominator All patients with AMI who are prescribed ticagrelor at discharge Denominator Exclusions Patients age <18 y Patients who leave against medical advice Patients who die during hospitalization Patients who are on comfort care measures only or hospice Patients who are transferred to another hospital for inpatient acute care Denominator Exceptions None Measurement Period Encounter Sources of Data Medical record or other database (eg, administrative, clinical, registry) Attribution Measure reportable at the facility or provider level Care Setting Inpatient Rationale In the PLATO (Platelet Inhibition and Patient Outcomes) trial, a prespecified subgroup analysis showed a significant regional variation in the comparative efficacy of ticagrelor with diminished benefits in North America compared with the rest of the world. Subsequent analyses demonstrated that the lowest risk of the composite ischemic outcome with ticagrelor compared with clopidogrel is associated with a low-maintenance dose of concomitant aspirin.7,12,40 Overall, a high- dose aspirin (>100 mg) is associated with increased bleeding hazard without an improved antiplatelet efficacy. The FDA also issued a boxed warning indicating that aspirin daily maintenance doses of >100 mg decrease the effectiveness of ticagrelor. Clinical Recommendation(s) 2013 ACCF/AHA Guideline for the Management of Patients With ST-Elevation Myocardial Infarction12 inhibitor therapy should be given for 1 year to patients with STEMI who receive a stent (bare-metal or drug-eluting) during primary PCI using the following maintenance doses: a. Clopidogrel 75 mg daily115,116 (Class I, Level of Evidence: B); or b. Prasugrel 10 mg daily115 (Class I, Level of Evidence: B); or c. Ticagrelor 90 mg twice a day*117 (Class I, Level of Evidence: B) *The recommended maintenance dose of aspirin to be used with ticagrelor is 81 mg daily. 