Patients taking OACs constitute 12% to 20% of patients a rate that has increased with the aging popu- lation and increased use of anticoagulant drugs in recent Vitamin K antagonists (VKAs) such as warfarin are the most frequently prescribed OAC, but new agents that do not require laboratory monitoring and do not necessarily prolong coagulation screening tests are being increasingly used, including dabigatran,71 These new agents appear to be associated with a lower risk of ICH than VKAs.74 It is important that providers caring for ICH patients recognize the use of antithrombotic drugs or of an underlying coagulopathy in the initial evaluation of patients with ICH, so that the treatment strategy can include appropriate interventions. For patients with a known coagulation factor deficiency or platelet disorder, replacement of the appropriate factor or platelets, often with the assistance of a consultant hema- tologist, is indicated. 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. 