This study compared the clinical and radiological outcomes of patients with intracerebral hemorrhage (ICH) associated with direct oral anticoagulants (DOACs) treated with prothrombin complex concentrate (PCC) versus conservative management. The study included 232 patients with DOAC-associated ICH, with a mean age of 77.2 years, 44% female, and 101 patients receiving conservative treatment, 102 receiving PCC, and 14 receiving idarucizumab. The primary outcome was good neurological recovery (modified Rankin Scale 0-3 or return to baseline function at 3 months), and secondary outcomes included 90-day mortality, in-hospital mortality, and hematoma expansion. PCC treatment was not associated with improved neurological recovery, mortality, or reduced hematoma expansion compared to conservative management. Higher baseline hematoma volume, lower Glasgow Coma Scale, and intraventricular hemorrhage were associated with poorer neurological outcomes. The study found that 31% of patients achieved good neurological recovery, and 39% died within 90 days. The study concluded that PCC treatment did not improve functional outcomes, hematoma expansion, or mortality in patients with DOAC-associated ICH. Further research is needed to identify the best management algorithm for DOAC-associated ICH, including novel hemostatic agents and neurosurgical or adjunctive medical therapies. The study highlights the high risk of mortality and functional disability in patients with DOAC-associated ICH, and the need for alternative hemostatic therapies, especially among Asian patients. The study also noted that the results may be influenced by factors such as baseline hematoma volume, cerebral small vessel disease, and differences in DOAC metabolism among ethnic groups.This study compared the clinical and radiological outcomes of patients with intracerebral hemorrhage (ICH) associated with direct oral anticoagulants (DOACs) treated with prothrombin complex concentrate (PCC) versus conservative management. The study included 232 patients with DOAC-associated ICH, with a mean age of 77.2 years, 44% female, and 101 patients receiving conservative treatment, 102 receiving PCC, and 14 receiving idarucizumab. The primary outcome was good neurological recovery (modified Rankin Scale 0-3 or return to baseline function at 3 months), and secondary outcomes included 90-day mortality, in-hospital mortality, and hematoma expansion. PCC treatment was not associated with improved neurological recovery, mortality, or reduced hematoma expansion compared to conservative management. Higher baseline hematoma volume, lower Glasgow Coma Scale, and intraventricular hemorrhage were associated with poorer neurological outcomes. The study found that 31% of patients achieved good neurological recovery, and 39% died within 90 days. The study concluded that PCC treatment did not improve functional outcomes, hematoma expansion, or mortality in patients with DOAC-associated ICH. Further research is needed to identify the best management algorithm for DOAC-associated ICH, including novel hemostatic agents and neurosurgical or adjunctive medical therapies. The study highlights the high risk of mortality and functional disability in patients with DOAC-associated ICH, and the need for alternative hemostatic therapies, especially among Asian patients. The study also noted that the results may be influenced by factors such as baseline hematoma volume, cerebral small vessel disease, and differences in DOAC metabolism among ethnic groups.