The PRESTIGE-AF study investigated the risks and benefits of direct oral anticoagulants (DOACs) as stroke prevention after an intracerebral hemorrhage event. In the presence of atrial fibrillation (AF), survivors of this particular kind of stroke are highly vulnerable to ischemic stroke and cardiovascular problems. While DOACs appear to prevent ischemic stroke in AF patients with no history of intracerebral hemorrhage, whether the same holds true for those with intracerebral hemorrhage is uncertain. Researchers worked with a sample of participants, 158 of whom were randomized to receive anticoagulation and 161 who were assigned to no anticoagulation. Over a median follow-up of 1.4 years, first ischemic stroke occurred less frequently in the DOAC group than in the no-anticoagulation cohort. However, the event rate of all intracerebral hemorrhage events was 5.0 per 100 patient-years vs. 0.82 for the no-anticoagulant patients. There were more serious adverse events in the group not receiving anticoagulation. The findings suggest that anticoagulants do prevent ischemic stroke in this at-risk patient population but elevate the risk of recurrent intracerebral hemorrhage. More research is needed to optimize stroke prevention in these patients.