Hemphill et al Performance Measures for ICH e251 Appendix. Continued 2. Coagulopathy Reversal: Percentage of patients with ICH and an INR >1.4 resulting from warfarin treatment who receive therapy to replace vitamin K dependent clotting factors within 90 min of ED presentation and who also receive intravenous vitamin K* Numerator Patients with an INR >1.4 resulting from warfarin treatment who receive therapy to replace vitamin K dependent clotting factors within 90 min of ED presentation and who also receive intravenous vitamin K* Denominator Included patients: Patients with ICH with known onset (or last known well) within 12 h of ED presentation Known or presumed current warfarin use Excluded patients: <18 y of age Documented contraindication to treatment with an anticoagulant reversal agent Clear documentation for comfort care/palliative care measures established before hospital arrival Length of stay >120 d Enrolled in a clinical trial that would affect the use of anticoagulant reversal agents Use of nonwarfarin anticoagulants Elevated INR not resulting from warfarin (eg, liver disease) Hospital transfer from another presenting ED where therapy to replace vitamin K dependent clotting factors was already started Period of Assessment Initial 90 min after ED arrival Sources of Data Prospective flowsheet, retrospective medical record review, electronic medical record, pharmacy records Rationale Coagulopathy, specifically that resulting from the vitamin K antagonist warfarin, is a significant risk factor for hematoma expansion in ICH, and outcome is worsened in these patients. Time to correction of an elevated INR caused by warfarin has been related to amount of hematoma expansion. Prothrombin complex concentrates and fresh-frozen plasma decrease the INR and quickly reverse the anticoagulant effect of warfarin. Vitamin K is needed to ensure that coagulopathy does not return after the effect of initial reversal has passed. 