Brief description of measure: ​CMS72/STK-5: Antithrombotic Therapy By End of Hospital Day 2 Ischemic stroke patients administered antithrombotic therapy by the end of hospital day 2 Description of issue: ​The AHA/ASA clinical guidelines were updated in October 2019 which identified Tenecteplase as a new thrombolytic therapy drug. Tenecteplase is a modified version of alteplase. Two new recommendations for tenecteplase resulted in modification of the STK-5 data element Thrombolytic (t-PA) Therapy at This Hospital or Within 24 Hours Prior to Arrival. This data element is a denominator exclusion.  Below are the two statements from Powers et al. (2019) and the American Heart Association and American Stroke Association (AHA/ASA) Clinical Guidelines Writing Group  that relate to Tenecteplase for the management of acute ischemic stroke (AIS): 1. It may be reasonable to choose tenecteplase (single IV bolus of 0.25-mg/kg, maximum 25 mg) over IV alteplase in patients without contraindications for IV fibrinolysis who are also eligible to undergo mechanical thrombectomy. 2. Tenecteplase administered as a 0.4-mg/kg single IV bolus has not been proven to be superior or noninferior to alteplase but might be considered as an alternative to alteplase in patients with minor neurological impairment and no major intracranial occlusion. Although Tenecteplase is not indicated to be superior or inferior to alteplase, one benefit is that it may be administered in a single IV bolus rather than initial bolus followed by IV infusion over 60 min. Goal of review: Obtain clinical feedback.

Proposed solution: Add applicable RxNORM concepts for Tenecteplase (TNK) initiation to the 'Thrombolytic (t-PA) Therapy' value set (OID: 2.16.840.1.113883.3.117.1.7.1.226) as an appropriate therapy for treatment of acute stroke.  Update the header to include the following guidance regarding the use of Tenecteplase. 1. It may be reasonable to choose tenecteplase (single IV bolus of 0.25-mg/kg, maximum 25 mg) over IV alteplase in patients without contraindications for IV fibrinolysis who are also eligible to undergo mechanical thrombectomy. 2. Tenecteplase administered as a 0.4-mg/kg single IV bolus has not been proven to be superior or noninferior to alteplase but might be considered as an alternative to alteplase in patients with minor neurological impairment and no major intracranial occlusion. Rationale for change: We are proposing this change to align with more recent clinical guidelines published, which support Tenecteplase as an appropriate thrombolytic therapy for acute stroke patients.