OBJECTIVE: The use of anticoagulants to prevent deep vein thrombosis (DVT) after intracerebral hemorrhage (ICH) remains controversial. This study aims to evaluate the safety of anticoagulants in preventing DVT in patients with ICH. METHODS: Data were sourced from the Chinese Stroke Center Alliance. The primary outcomes include in-hospital mortality, intracranial hematoma evacuation, and hematoma expansion. Absolute standardized differences (ASD) are used to assess differences between groups, and multivariate logistic regression analysis is employed to analyze correlations. Platelet counts and international normalized ratio (INR) were examined within subgroups. Propensity score matching (PSM) is used for sensitivity analysis. RESULTS: A total of 56,633 patients with ICH were finally enrolled. Multivariate logistic regression analysis revealed that anticoagulant use correlated with reduced in-hospital mortality and hematoma expansion (OR: 0.59, 95% CI: 0.50-0.69, p <
0.001 and OR: 0.55, 95% CI: 0.41-0.73, p <
0.001), while no association was observed with intracranial hematoma evacuation clearance (OR: 1.00, 95% CI: 0.93-1.08, p = 0.941). Subgroup analysis revealed an increased risk of intracranial hematoma evacuation with anticoagulant use when INR >
1.7 (OR: 1.47, 95% CI: 1.15-1.89, p = 0.002), but not of in-hospital mortality (OR: 1.20, 95% CI: 0.78-1.85, p = 0.409) or hematoma expansion (OR: 0.66, 95% CI: 0.19-2.25, p = 0.503). PSM yielded consistent outcomes. CONCLUSIONS: Post-ICH anticoagulant therapy to prevent DVT is safe, posing no heightened risk of in-hospital mortality, intracranial hematoma evacuation, or hematoma expansion. However, caution is warranted in patients with coagulopathies.