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Objective: Patients on antiplatelet (AP) or anticoagulant (AC) agents cause more alarm when they develop intracerebral hemorrhage (ICH) compared with non-users. This analysis aimed to quantitatively evaluate the differences in the hospital course of ICH patients based on underlying AP and/or AC use, using a population-based cohort.Methods: Genetic and Environmental Risk Factors for Hemorrhagic Stroke (GERFHS III) was a population-based study of spontaneous ICH among residents of the five-county Greater Cincinnati/Northern Kentucky region between July 2008 and December 2012. Baseline demographics, medications, hospital course, and discharge disposition were collected. Initial and subsequent computed tomography (CT) images of the head were reviewed to assess ICH location, volume, and presence of intraventricular hemorrhage (IVH). Change in ICH volume was calculated when repeat CT image was available.Results: There were 1121 cases of ICH during the study period. A higher proportion of white patients were on AP or AC than other races (56.4% vs. 39.7%, p<.0001). The majority of patients with subsequent imaging experienced an increase in ICH size. Patients taking AC pre-ICH had a larger increase in volume despite more frequent use of pro-thrombotic therapy. There was no difference in IVH incidence based on AP or AC use. Length of stay and surgical hematoma evacuation rates were similar among the groups. Inpatient mortality was higher in AC users (44.4% vs. 21.3%, p<.0001), but was virtually the same for AP users as for non-users. Of 272 pre-ICH AP users, 86 (31.6%) were discharged on AP (8 on dual AP). Of 91 pre-ICH AC users, 11 (12%) were discharged on AC.Conclusion: Pre-ICH AC use was associated with greater ICH volume increase and inpatient death. There was no significant difference in number of IVH, rate of surgical treatment, or length of stay. Inpatient mortality did not differ between AP users and non-users.