Continued 39 Short Title: QM-6: Inappropriate Prasugrel at Discharge in TIA/Stroke Patients QM-6: AMI: Inappropriate Prescription of Prasugrel at Discharge in Patients With a History of Prior Stroke or TIA Measure Description: Percentage of patients, age 18 y, hospitalized with AMI, who had a history of prior stroke or TIA and who are inappropriately prescribed prasugrel at discharge. Numerator Patients with AMI who are prescribed prasugeral at discharge Denominator All patients with AMI and a history of prior stroke (ischemic or hemorrhagic) or TIA 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 The TRITON-TIMI 38 (Trial to Assess Improvement in Therapeutic Outcomes by Optimizing Platelet Inhibition with Prasugrel Thrombolysis in Myocardial Infarction) randomized clinical trial demonstrated the superiority of prasugrel over clopidogrel in reducing the composite of cardiovascular death, nonfatal MI, or nonfatal stroke among AMI patients (albeit with an increased risk of major bleeding). Although the elderly and underweight patients did not experience net clinical benefit from the use of prasugrel, the subgroup of patients with TIA or stroke had an increased net clinical harm with prasugrel compared with clopidogrel.12,116 Notably, a history of ischemic or hemorrhagic stroke or TIA symptoms were considered exclusion criteria in the TRITON-TIMI 38 trial, although a small group ended up being randomized in error and exhibited increased harm with prasugrel. Subsequently, the FDA issued a boxed warning cautioning against the use of prasugrel in patients with TIA or stroke. 