Introduction Stroke remains a major health concern globally, with oral anticoagulants widely prescribed for stroke prevention.

Aim of Study The efficacy and safety of mechanical thrombectomy (MT) in anticoagulated patients with medium vessel occlusions (MeVO) are not well understood, we evaluated it.

Methods This retrospective analysis involved 1,733 AIS patients who underwent MT in 37 centers across America, Asia, and Europe from September 2017 to July 2021. Data on demographics, clinical presentation, treatment, and outcomes were collected. The primary outcomes were functional outcomes at 90 days post-MT, measured by modified Rankin Scale (mRS) scores. Secondary outcomes included reperfusion rates, mortality, and hemorrhagic complications. Statistical analyses included Chi-square, Mann-Whitney U test, multiple imputation for missing data, and propensity score matching (PSM) to adjust for potential confounders.

Results Of the patients, 312 (24%) were on anticoagulation therapy. Anticoagulated patients tended to be older (median age 72 vs. 64 years; p<0.0001) and had a higher prevalence of atrial fibrillation (73% vs. 24%; p<0.0001). Their baseline NIHSS scores were also higher (median 12 vs. 10; p=0.012). Before PSM, anticoagulated patients had lower rates of favorable 90-day outcomes (mRS 0-1: 32% vs. 39%, p=0.033; mRS 0-2: 46% vs. 56%, p=0.0051) and higher mortality (26% vs. 14%, p<0.0001). After PSM, there were no significant differences in outcomes between the two groups.

Conclusion Anticoagulated patients undergoing MT for AIS due to MeVO did not show significant differences in 90-day mRS outcomes, reperfusion, or hemorrhage compared to non-anticoagulated patients after adjustment for covariates.