Combination Antithrombotic Treatment for Prevention of Recurrent Ischemic Stroke in Intracranial Atherosclerotic Disease

Exclusion Criteria

• •1. Indication for DAPT for \> 90 days on guideline recommendations or investigator ́s judgment; e.g., cardiac stenting.
• •2. Indication for chronic anticoagulation based on guideline recommendations or investigator ́s judgment; e.g. patient with prosthetic mechanical valve, venous thromboembolism, hypercoagulable state
• •3. Atrial fibrillation or a history of atrial fibrillation
• •4. Intracranial arterial occlusion (e.g. 100% stenosis) responsible for the acute brain ischemia
• •5. Intracranial arterial stenosis secondary to causes other than atherosclerosis
• •6. Extracranial carotid artery disease ipsilateral to the qualifying brain ischemia with a plan for carotid revascularization
• •7. Intraluminal thrombus
• •8. Subdural hematoma within 12 months of randomization
• •9. Previous spontaneous hemorrhagic stroke (e.g. intracerebral or subarachnoid hemorrhage)
• •10. Traumatic brain hemorrhage within 1 month of randomization
• •11. Contraindication for MRI scan (e.g. pacemaker incompatible with MRI)
• •12. Advanced kidney disease (recent estimated GFR \<30 ml per minute)
• •13. Modified Rankin Scale (mRS) \>=4 at entry
• •14. Platelet count less than 100,000/mm3 at enrolment or other bleeding diathesis
• •15. Uncontrollable hypertension with systolic BP/ diastolic BP consistently above180/100mmHg after treatment
• •16. Known hypersensitivity to either ASA or rivaroxaban
• •17. Life expectancy less than 6 months
• •18. Concomitant use of strong inhibitors of both cytochrome P450 isoenzyme 3A4 (CYP3A4) and P-glycoprotein (P-gp), i.e., human immunodeficiency virus protease inhibitors and the following azole-antimycotics agents: ketoconazole, itraconazole, voriconazole, or posaconazole, if used systemically
• •19. Female of childbearing potential who are not surgically sterile, or, if sexually active not willing to use adequate contraceptive measures with a failure rate less than 1% per year (e.g., prescription oral contraceptives, contraceptive injections, intrauterine device, double-barrier method, male partner sterilization) before entry and throughout the study, as well as pregnant or breast-feeding women
• •20. Inability to adhere to study procedures
• •21. Close affiliation with the investigational site; e.g. a close relative of the investigator, dependent person (e.g., employee or student of the investigational site)
• •22. Previous randomization to this study or participating in a study with an investigational drug or medical device at the time of randomization
• •23. Antiphospholipid antibody syndrome