If spontaneous ICH occurs in a patient undergoing an intravenous heparin infusion, then protamine sulfate can be given by intravenous injection at a dose of 1 mg per 100 U of heparin (maximum dose 50 mg), with adjustment based on time elapsed since discontinuation of heparin infu- Similar dosing can be used in patients who are receiv- ing low-molecular-weight heparin; however, reversal may be VKA-Related ICH Guidelines exist for reversal of OACs.76 For ICH patients tak- ing VKA, rapid correction of the international normalized ratio (INR) is recommended.76,77 Fresh frozen plasma (FFP), along with vitamin K, has been the mainstay of treatment in the United States for years, but more recently, prothrombin complex concentrates (PCCs), the activated PCC FEIBA (fac- tor VIII inhibitor bypassing activity), and recombinant acti- vated factorVIIa (rFVIIa) have emerged as potential therapies. Administration of intravenous vitamin K alone is insufficient for reversal in the first hours but should be part of all acute VKA reversal strategies in a dose of 5 to 10 mg, usually given slowly via the intravenous route. Onset of action begins by 2 hours and is maximal at 24 hours if liver function is normal.78 FFP administration requires thawing and cross matching, car- ries a risk of allergic and infectious transfusion reactions, and often requires large volumes for full INR correction. Likelihood of INR correction at 24 hours was linked to time to FFP administration in 1 study, although 17% of patients still did not have an INR <1.4 by this time, which suggests that FFP administered in this manner may be insufficient for rapid correction of coagulopathy.79 Shortcomings of FFP have led to interest in alternative agents for VKA reversal. PCCs are plasma-derived factor concentrates originally developed to treat factor IX deficiency (hemophilia B). 