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Introduction Low platelet counts are a frequent cause of concern in acute ischemic stroke management due toimplications for reperfusion therapy decision-making. However, low platelet count association with functionaloutcomes and Endovascular Thrombectomy(EVT) treatment effect among patients with large core at presentationis not well-explored.Methods In a secondary analysis of SELECT2 data, patients were stratified using the platelet count threshold of150,000/µl at time of presentation. Baseline clinical and imaging characteristics as well as functional and safetyoutcomes were compared between the groups, with further stratification based on the type of treatmentreceived(EVT vs Medical Management[MM]). A sensitivity analysis of outcomes among patients with platelet counts<100,000/µl was also attempted.Results Of 336 patients with available platelet counts at baseline, 36 (10.7%, 18 EVT, 18 MM) had platelet counts<150,000/µl. Patients with low platelets at presentation had more frequent history of CHF, CAD and TIAs, but similarage, stroke severity, CT ASPECTS and ischemic core volume as compared to those without low platelets. Low plateletcount was independently associated with worse mRS scores(low platelets: 6[5,6] vs normal platelets : 5[3,6],aGenOR: 0.65, 95% CI: 0.45 to 0.92, p-value: 0.017) and increased complete dependence or death – mRS 5-6(78% vs52%, aRR: 1.35, 95% CI: 1.08 to 1.70, p-value: 0.009) at 90-day follow-up, figure 1. Consistent findings were observedin MM arm, with worse 90-day-mRS (aGenOR: 0.60, 95% CI: 0.38 to 0.94, p-value: 0.024); whereas low platelet countwas associated with increased mortality(61% vs 38%, aRR: 1.57, 95% CI: 1.03 to 2.38, p-value: 0.035) and mRS 5-6(aRR: 1.47, 95% CI: 1.08 to 2.00, p-value: 0.015) among EVT, while overall functional outcomes numericallyworsened but did not reach statistical significance (6[4,6] vs 4[3-6], aGenOR: 0.74, 95% CI: 0.42 to 1.29, p-value:0.285). However, no significant modification of EVT treatment effect was observed based on platelet counts, andsevere hemorrhagic transformation with EVT was infrequent(1/18 sICH, 1 additional PH1). A sensitivity analysisamong patients with platelet counts <100,000/µl demonstrated universally poor outcomes, as 4/4 EVT and 3/5 MMpatients died at 90-day follow-up.Conclusions Low platelet count (<150,000/µl) was independently associated with poor outcomes in patients withlarge core strokes - overall and within patients treated with EVT and MM, but did not modify EVT treatment effect.Platelet counts can serve as a prognostic marker for patients presenting with large core strokes, and furtherexploration of these findings is warranted.Disclosures K. Duncan: None.Abstract E-088 Figure 1Stacked bar chart for mRS scores at 90-day follow-up - stratified based on platelet count and treatment received