Vitamin K is needed to ensure that coagulopathy does not return after the effect of initial reversal has passed. Source for Recommendations From the 2015 AHA/ASA Guidelines for the Management of Spontaneous Intracerebral Hemorrhage Patients with ICH whose INR is elevated because of vitamin K antagonist should have their vitamin K antagonist withheld, receive therapy to replace vitamin K dependent factors and correct the INR, and receive intravenous vitamin K (Class I; Level of Evidence C). Recombinant factor VIIa does not replace all clotting factors, and although the INR may be lowered, clotting may not be restored in vivo; therefore, recombinant factor VIIa is not recommended for vitamin K antagonist reversal in ICH (Class III; Level of Evidence C). Method of Reporting Per patient: documentation of administration of therapy to replace vitamin K dependent clotting factors within 90 min of arrival to the presenting ED Per patient population: percentage of patients treated with therapy to replace vitamin K dependent clotting factors within 90 min of arrival to the presenting ED Challenges to Implementation Documentation of time of symptom onset or last known well is not always recorded for ICH. Initiation of coagulopathy reversal agent does not necessarily guarantee adequate INR correction. Analogous Measures Endorsed by Other Organizations Analogous measure used by TJC (CSTK-04) AHA indicates American Heart Association; ASA, American Stroke Association; CSTK, Comprehensive Stroke; ED, emergency department; ICH, intracerebral hemorrhage; INR, international normalized ratio; and TJC, The Joint Commission. *Acceptable therapies to meet the 90-minute door-to-needle time metric include prothrombin complex concentrate (preferable) or fresh-frozen plasma (acceptable). Treatment with vitamin K alone is not acceptable to meet this measure. However, to meet this performance measure, intravenous vitamin K must also be given. A specific time for the vitamin K administration is not delineated. 