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Introduction The medical management of intracranial arteriovenous malformations (AVM) is primarily limited to the symptomatic control of headaches and seizures, with currently no medical therapy available to reduce the risk of intracranial hemorrhage (ICH). The goal of the study is to evaluate the effect of Glucagon-like peptide-1 receptor agonists (GLP-1RAs) use on the incidence of ICH and mortality in patients with unruptured and untreated AVMs.Methods This is a retrospective nationwide cohort study of the TriNetX database from 2016 to 2025. Patients with newly diagnosed unruptured AVMs who did not subsequently undergo embolization, resection, or radiosurgery or develop an ICH within three months of diagnosis were included. Primary endpoints were ICH and mortality and were evaluated at 1-, 3-, and 5- years post diagnosis using 1:1 propensity score matching (PSM).Results Propensity score matching yielded 570 well balanced pairs. At all timepoints post-AVM diagnosis, patients in the GLP-1RA group experienced significantly lower rates of ICH compared to PSM controls (5 year: Hazard ratio (HR): 0.46; 95%CI: 0.28-0.78 p=0.003. Similarly, patients receiving GLP-1RA experienced significantly lower risk of mortality at 1-, 3-, and 5- years (HR 0.54; 95%CI: 0.33-0.88 p=0.012) post AVM diagnosis.Conclusions In patients with unruptured, untreated AVMs, GLP-1RA use is significantly associated with decreased all-cause mortality by 60% and ICH risk by 55% at 5 years compared to matched controls. While prospective study is needed, these findings support the use of GLP-1RA in the medical management of unruptured and untreated intracranial AVMs in patients with obesity, diabetes, and metabolic syndrome.Disclosures M. McIntyre: 1; C; The Aneurysm & AVM Foundation. J. Abarricia: None. J. Kakadiya: None. P. Rai: None. A. Malhotra: None. D. Lakhani: None.