More than a third of adults who experience primary intracranial hemorrhage (ICH) in high-income countries are prescribed antiplatelet medications due to similar risk factors shared with vascular occlusive diseases [1–3]. The decision to resume antiplatelet therapy is challenging for physicians, as they must balance the need for preventing vascular occlusive events against the risk of re-bleeding, particularly where major hemorrhage is the initial presentation. Previous studies on resuming antiplatelets in primary ICH patients have yielded mixed results and lacked statistical power [1–7].