Highlight
1. Antiseizure medication (ASM) choice significantly affects thromboembolic, bleeding, and mortality risks in epilepsy patients treated with direct oral anticoagulants (DOACs).
2. Levetiracetam use is associated with nearly doubled thromboembolic risk and increased all-cause mortality compared to lamotrigine/lacosamide.
3. Strong enzyme-inducing ASMs elevate thromboembolic risk but reduce major bleeding events.
4. Valproate increases all-cause mortality and intracranial major bleeding risk, highlighting the nuanced safety profiles of ASMs during DOAC therapy.
