Background <p>Population-based studies on the association between anticoagulant use and the incidence of hemorrhagic stroke in older adults are limited. We examined the association between anticoagulant prescription and hospitalization for hemorrhagic stroke and whether this association varies between warfarin and direct oral anticoagulants (DOACs).</p> Methods <p>This propensity score-matched retrospective cohort study used medical insurance claim data from Hokkaido, Japan. Older adults aged ≥ 75 years receiving medical care between April 2016 and March 2017 (baseline period) were included. The exposure variable was prescription of anticoagulants during the baseline period and outcome variable was hospitalization for hemorrhagic stroke between April 2017 and March 2020. A one-to-one matched design adjusted for covariates (age, sex, copayment rate, comorbidities, annual health check-up, and care needs certification) compared the incidence of hospitalization between patients prescribed and those not prescribed anticoagulants.</p> Results <p>Among 717,097 patients, 66,916 (9.3%) were prescribed anticoagulants. After propensity score matching, the incidence of hospitalization for hemorrhagic stroke was higher in patients prescribed anticoagulants (383.2 per million person-month) than in those who were not prescribed anticoagulants (252.2 per million person-month) (hazard ratio [HR] = 1.64; 95% Confidence interval [CI], 1.39–1.93). Moreover, among patients prescribed one anticoagulant (<i>n</i> = 61,556), after matching, the incidence of hospitalization for hemorrhagic stroke was significantly higher in patients prescribed warfarin than in those prescribed DOACs (HR, 1.67; 95% CI, 1.39–2.01).</p> Conclusions <p>The findings of this study highlight the need for careful consideration when prescribing anticoagulants, particularly warfarin, to older adults to minimize the risk of hemorrhagic stroke.</p>