Intracranial hemorrhage (ICH) is associated with high morbidity and mortality, with mortality rates up to 65% [1,2]. Oral anticoagulants (OAC) are a major risk factor for ICH and current guidelines recommend rapid reversal of anticoagulation to decrease hematoma expansion and reduce mortality in OAC-associated ICH [2].

These patients often present in the emergency department first, so an EM pharmacist can play a significant role to ensure appropriate selection, dosing, and delivery of medications during acute resuscitative efforts in the ED [3]. Blood factor stewardship, including assessment of appropriate indication and dosing of four-factor prothrombin complex concentrate (4F-PCC), was identified as the third-largest category of potential cost avoidance for EM pharmacists when quantifying impact of interventions in the ED [4].

Previous studies have been conducted evaluating the use of 4F-PCC and vitamin K specifically for warfarin reversal for emergent bleeding or need for urgent procedures. However, no studies have analyzed the use of newer reversal agents for direct oral anticoagulants (DOACs). Additionally, previous studies have been limited by strict inclusion criteria and differences in hospital operations (such as blood bank dispensing processes). Due to these factors, the EM pharmacist role in reversal agent administration has had an unclear impact on length of stay (LOS) and other clinical outcomes [[5], [6], [7], [8], [9]].

Given the emergent nature of OAC reversal in patients presenting with an ICH, it is necessary to evaluate strategies to reduce the time to reversal agent administration. The purpose of this study is to determine the impact EM pharmacist presence has on time to reversal in patients presenting with OAC-associated ICH.