A Study of Milvexian in Participants After a Recent Acute Coronary Syndrome

Inclusion Criteria:

• Participants must have an index event that meets all 3 of the following criteriawithin 7 days prior to randomization: a) clinical syndrome consistent withspontaneous cardiac ischemia, b) diagnosis of acute coronary syndrome (ACS) (thatis, ST-elevation myocardial infarction [STEMI], non-STEMI, or unstable angina [UA]),c) cardiac biomarker elevation (example, troponin I, troponin T, creatine kinase-MB [CK-MB]) above the upper limit of normal as determined by the local laboratory

• Participants must have at least 2 of the following risk factors:a) age 65 or older,b) diabetes mellitus, c) history of a prior myocardial infarction (MI) (other thanindex ACS event), d) multivessel coronary artery disease (CAD), e) history ofcoronary artery bypass graft (CABG) surgery prior to index ACS event, f) history ofperipheral artery disease (PAD) or cerebrovascular disease (example, carotidatherosclerosis, intracranial artery stenosis, g) conservative management (that is,no percutaneous intervention [PCI] or CABG after index ACS event), h) Any one ormore of the following high-risk angiographic features i) total stent length ofgreater than (>) 30 millimeters (mm), ii) thrombotic target lesion, iii) bifurcationlesion treated with more than one stent, iv) calcified target lesion treated withatherectomy, v) treatment of obstructive left main or proximal left anteriordescending artery for index ACS (or clinical diagnosis of an anterior STEMI)

• All female participants of childbearing potential must have a negative highlysensitive serum beta-human chorionic gonadotropin (hCG) or urine test at screening

• A female participant must not be pregnant, breastfeeding, or planning to becomepregnant until 4 days (5 half-lives) after the last dose of study intervention

Exclusion Criteria:

• MI secondary to ischemia due to either increased oxygen demand or decreased supply (Type 2 MI) or periprocedural MI as the index ACS event

• Planned CABG or staged PCI after randomization

• Any condition that requires chronic anticoagulation at the discretion of theinvestigator and/or local guidelines

• Conditions with a significant increased risk of bleeding (example, clinicallysignificant bleeding within previous 3 months, known bleeding diathesis, et cetera)