A Study of Milvexian in Participants After an Acute Ischemic Stroke or High-Risk Transient Ischemic Attack- LIBREXIA-STROKE

Inclusion Criteria:

• Ischemic Stroke: a neurological deficit attributable to an acute brain infarctionand national institute of health stroke score scale (NIHSS) score less than or equalto (<=) 7 and at least 1 of the following: persistent signs or symptoms of theischemic event at the time of randomization, or acute, ischemic brain lesiondetermined by standard-of-care neuroimaging, or participant underwent thrombolysisor thrombectomy, or transient ischemic attack (TIA): acute onset neurologicaldeficit attributable to focal ischemia of the brain by history or examination, withcomplete symptom resolution of the deficit and no brain infarction on neuroimaging (example, computed tomography (CT) scan or magnetic resonance imaging (MRI),performed as part of standard medical practice), and ABCD2 Score greater than orequal to (>=) 6

• Participants will be randomized as soon as possible after determining eligibilityand within 48 hours of onset of event.

• Current or planned antiplatelet treatment per international and/or local guidelines.If acetyl salicylic acid (ASA) is used, it will be limited to low dose (75 to 100milligrams (mg)/day). Loading dose of antiplatelet agents (including ASA) areallowed per standard-of-care

• A female participant must agree not to be pregnant, breastfeeding, or planning tobecome pregnant until 4 days (5 half lives) after the last dose of studyintervention

• Willing and able to adhere to the lifestyle restrictions specified in this protocol

Exclusion Criteria:

• Prior history of intracranial hemorrhage except subarachnoid hemorrhage greater than (>) 1 year prior with adequate treatment

• The index stroke or TIA is considered to have a cardio-embolic etiology based onlocal standard-of-care investigations and for which guidelines recommendanticoagulation

• The index stroke or TIA considered to have another known cause, not related toathero-thrombotic sources (treatment of acute stroke trial [TOAST] Other DeterminedEtiology), based on local standard-of-care investigations

• Increased risk of bleeding, including clinically significant bleeding within theprevious 3 months or known bleeding diathesis or known activated partialthromboplastin time (aPTT) prolongation or spinal cord hemorrhage or retinalhemorrhage

• Current active liver disease, eg, acute hepatitis, known cirrhosis, includingparticipants receiving antiviral treatment for hepatitis

• Known allergies, hypersensitivity, or intolerance to milvexian or its excipients