The safety and efficacy of anti-thrombotic agents during mechanical thrombectomy procedure for acute ischemic stroke: A systematic review and meta-analysis.

Objective: Ischemic stroke, primarily driven by large-vessel atherosclerosis, is frequently treated with mechanical thrombectomy (MT). While anti-thrombotic agents during MT procedure are commonly used, their risk-benefit profile remains unclear. This study compares the safety and efficacy of anti-thrombotic administration in acute ischemic stroke patients undergoing MT. Methods: We systematically searched PubMed, ScienceDirect, and Google Scholar for studies evaluating anti-thrombotic use during MT. Data were analyzed using Review Manager (Web Version). We calculated odds ratios (OR) with 95% confidence intervals (CI) for safety outcomes (sICH and 3- to 6-month mortality) and efficacy outcomes (successful recanalization and functional independence). Results: Thirteen observational studies (n=4,923) were included. Anti-thrombotic use did not significantly alter the risk of sICH [OR 0.83 (95% CI 0.63-1.1); p=0.21; I2=25%]. However, it was associated with reduced 3-6-month mortality [OR 0.57 (95% CI 0.33-0.99); p=0.05; I2=86%], though heterogeneity was high. Regarding efficacy, anti-thrombotic use showed no significant association with successful recanalization [OR 1.22 (95% CI 0.81-1.83); p=0.63; I2=74%] or functional independence [OR 1.07 (95% CI 0.81-1.41); p=0.31; I2=73%]. Conclusions: Administration of anti-thrombotic agents during MT may reduce 3- to 6-month mortality without increasing sICH risk. However, they do not appear to significantly improve recanalization rates or functional independence. Given the high heterogeneity in mortality data, these results should be interpreted with caution.