Subsequently, the FDA issued a boxed warning cautioning against the use of prasugrel in patients with TIA or stroke. Overall, patients with prior history of ischemic or hemorrhagic stroke or TIA symptoms should not receive prasugrel. Although ischemic stroke is defined as a permanent infarction (symptomatic or asymptomatic) of the central nervous system, TIA is defined as a transient neurologic dysfunction caused by focal ischemia without ensuing infarction. Hemorrhagic strokes result from either subarachnoid or intracerebral bleeding, and usually represent 20% of all stroke events. Clinical Recommendation(s) 2013 ACCF/AHA Guideline for the Management of Patients With ST-Elevation Myocardial Infarction12 1. Prasugrel should not be administered to patients with a history of prior stroke or transient ischemic attack.116 (Class III, Level of Evidence: B) 2014 AHA/ACC Guideline for the Management of Patients With Non ST-Elevation Acute Coronary Syndromes11 1. Prasugrel should not be administered to patients with a prior history of stroke or transient ischemic attack.116 (Class III, Level of Evidence: B) ACC indicates American College of Cardiology; ACCF, American College of Cardiology Foundation; AHA, American Heart Association; AMI acute myocardial infarction; and TIA, transient ischemic attack. Appendix A. Continued 40 Short Title: QM-7: Inappropriate High-Dose Aspirin With Ticagrelor at Discharge QM-7: AMI: Inappropriate Prescription of High-Dose Aspirin With Ticagrelor at Discharge Measure Description: Percentage of patients, age 18 y, hospitalized with AMI who are prescribed ticagrelor and high-dose aspirin at discharge. Numerator Patients with AMI who are prescribed ticagrelor and high-dose aspirin at discharge Note: The recommended maintenance dose of aspirin is 81 mg daily in patients treated with ticagrelor. A high-dose aspirin is defined as a daily maintenance dose >100 mg. In the United States, a high-dose aspirin for thromboprophylaxis is usually a 162 mg or a 325-mg regimen. 