However, the writing group felt that the absence of any time frame for administra- tion did not appropriately reflect quality because treatment with prothrombin complex concentrates or fresh-frozen plasma at a time point outside the hyperacute period was not the intended approach and meeting the metric by treat- ing many hours after ictus was not reflective of quality care. Thus, initiation within 90 minutes of emergency department presentation (door-to-needle time) was chosen for this perfor- mance measure because it combines the expected time frame for the initial head computed tomography in stroke evaluation with treatment timing from a recent clinical trial of coagu- lopathy reversal. Although this new door-to-needle time for the initiation of coagulopathy reversal requires piloting, it is expected that high compliance will be achieved now and that future revisions will target a shorter door-to-needle time of 60 minutes, analogous to that for acute ischemic stroke. Per the recommendation in the 2015 ICH guidelines, intravenous vitamin K must also be administered to meet this performance measure. The fact that this measure applies to the present- ing hospital (or a transfer-receiving hospital if therapy was not started at the initial hospital) was considered important because it emphasizes that just transferring a patient with ICH is insufficient to meet certain performance measures that per- tain to early aspects of care. This measure deserves pilot test- ing, and it is reasonable for additional data such as type of treatment (prothrombin complex concentrates or fresh-frozen plasma) and time to international normalized ratio correction to be recorded. Again, public comment was generally support- ive of the requirement of an early time frame for treatment. The 2015 ICH guidelines did not include a Class I recommen- dation for reversal of newer anticoagulant agents such as dabi- gatran, rivaroxaban, or apixaban. 