Objective To investigate the effect of restarting antiplatelet therapy on clinical outcomes in elderly male patients with intracranial hemorrhage (ICH). Methods Clinical data of 113 elderly male ICH patients admitted in the Second Medical Center of Chinese PLA General Hospital from January 2006 to December 2021 were collected and retrospectively analyzed. According to whether antiplatelet therapy was restarted, they were divided into restart antiplatelet group (Re-AP, n=67) and non-restart antiplatelet group (Non-AP, n=46). Their baseline data and clinical outcomes (ischemic vascular events, recurrent ICH, all-cause death, and vascular death) were recorded. SPSS statistics 26.0 was used for data analysis. Depending on the data types, student′s t test, Mann-Whitney U test, Chi-square test, or Fisher′s exact test was employed for comparison between groups. Univariate and multivariate Cox proportional hazards regression models were applied to analyze the risk factors for clinical outcome events. Results The Re-AP group had larger proportions of atrial fibrillation and statin use, and lower ratio of lobar hemorrhage and lower serum creatinine level than the Non-AP group. The median time to restart antiplatelet therapy was 178 (46,780) d. Multivariate Cox regression analysis showed that restarting antiplatelet therapy was independently associated with a reduced risk of ischemic vascular events (HR=0.377,95%CI 0.160-0.888; P=0.026), but not associated with an increased risk of recurrent ICH (HR=1.563,95%CI 0.767-3.184; P=0.219), all-cause mortality (HR=0.734,95%CI 0.404-1.336; P=0.312) or vascular death (HR=0.454,95%CI 0.159-1.293; P=0.139). Age and elevated creatinine level were independent risk factors for all-cause mortality (HR=1.100,95%CI 1.048-1.155; P=0.000; HR=1.009, 95%CI 1.005-1.014; P=0.000), and elevated serum creatinine level was an independent risk factor for vascular death (HR=1.009, 95%CI 1.001-1.017; P=0.028). Conclusion In elderly male patients with ICH, restarting antiplatelet therapy after a median time of 178 d reduces the risk of ischemic vascular events and does not increase the risk of recurrence of ICH.