This study aimed to compare 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 was a population-based, propensity score-weighted retrospective cohort analysis of 232 Chinese patients with DOAC-associated ICH from January 1, 2016, to December 31, 2021, in Hong Kong. Patients were categorized into those who received PCC (n = 102) and those who received no hemostatic agents (n = 116). The primary outcome was good neurological recovery (modified Rankin scale of 0 to 3 or returning to baseline functional status at 3 months), while secondary outcomes included mortality at 90 days, in-hospital mortality, and hematoma expansion. Key findings: - 31% of patients achieved good neurological recovery. - 39% of patients died within 90 days. - PCC treatment was not associated with improved neurological recovery (adjusted odds ratio [aOR], 0.62; 95% CI, 0.33-1.16; P = .14). - PCC treatment was not associated with improved mortality at 90 days (aOR, 1.03; 95% CI, 0.70-1.53; P = .88). - PCC treatment was not associated with reduced hematoma expansion (aOR, 0.94; 95% CI, 0.38-2.31; P = .90). Higher baseline hematoma volume, lower Glasgow Coma Scale, and intraventricular hemorrhage were associated with lower odds of good neurological recovery but not hematoma expansion. 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 and adjunctive medical therapies.This study aimed to compare 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 was a population-based, propensity score-weighted retrospective cohort analysis of 232 Chinese patients with DOAC-associated ICH from January 1, 2016, to December 31, 2021, in Hong Kong. Patients were categorized into those who received PCC (n = 102) and those who received no hemostatic agents (n = 116). The primary outcome was good neurological recovery (modified Rankin scale of 0 to 3 or returning to baseline functional status at 3 months), while secondary outcomes included mortality at 90 days, in-hospital mortality, and hematoma expansion. Key findings: - 31% of patients achieved good neurological recovery. - 39% of patients died within 90 days. - PCC treatment was not associated with improved neurological recovery (adjusted odds ratio [aOR], 0.62; 95% CI, 0.33-1.16; P = .14). - PCC treatment was not associated with improved mortality at 90 days (aOR, 1.03; 95% CI, 0.70-1.53; P = .88). - PCC treatment was not associated with reduced hematoma expansion (aOR, 0.94; 95% CI, 0.38-2.31; P = .90). Higher baseline hematoma volume, lower Glasgow Coma Scale, and intraventricular hemorrhage were associated with lower odds of good neurological recovery but not hematoma expansion. 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 and adjunctive medical therapies.