INTRODUCTION: Direct oral anticoagulants have demonstrated efficacy and safety in cerebrovascular prevention. We aimed to investigate the safety and efficacy of mechanical thrombectomy in patients with major vascular occlusion while receiving DOAC, and to evaluate the clinical characteristics and treatment outcomes of patients. METHODS: A retrospective study of prospectively collected data based on data from the registry of the Osmangazi University was performed between January 2015 and December 2019. All patients have cardioembolic etiology. We collected the demographics, clinical and brain imaging, and stroke etiology. A good outcome was defined as a modified Rankin Scale (mRS) score ≤0-2 at three months follow-up. RESULTS: 140 patients were included. Patients were classified and compared into two study groups according to DOAC at admission. There were no differences in basic demographics, clinical characteristics, and vascular risk factors between the two groups, A total of 23 patients adherent with DOAC were admitted, All patients, except 2, were using DOAC regularly. 69.6% of the patients receiving DOAC and 84.3% of the other group were fully recanalized (TICI 2b-3) (p=0.18). No significant difference was observed in intracranial hemorrhage, The Thrombolysis in Cerebral Infarction (TICI) score, and mortality between patients with and without DOAC. The patients with mRS ≤0-2 were 26.1% in the DOAC group and 53.8% in the other group. This difference was statistically significant (p=0.02). DISCUSSION AND CONCLUSION: Despite similar recanalization rates, 3rd-month mRS scores were worse in patients receiving DOAC. In conclusion, given the complexity of the clinical situation, it would be beneficial to establish standardized protocols for the development of endovascular treatment.