Early Antiplatelet Administration After Intravenous Thrombolysis for Acute Ischemic Stroke (TREND-IVT)

Inclusion Criteria:

1. Age ≥18 years old;

2. Acute ischemic stroke treated with intravenous thrombolysis with alteplase ortenecteplase within 4.5 hours of onset or time last known well and can receive thestudy drug treatment within 3 hours of initiating intravenous thrombolysis.

3. NIHSS score improvement ≤ 2 points or worsening ≤ 4 points one hour after initiatingintravenous thrombolysis compared to pre-thrombolysis.

4. Residual NIHSS score > 5 points at randomization.

5. Informed consent obtained from patients or their acceptable surrogates.

Exclusion Criteria:

1. Stroke caused by definite large vessel occlusion (including A1 and A2 segments ofthe anterior cerebral artery, M1 and M2 segments of the middle cerebral artery, P1and P2 segments of the posterior cerebral artery, intracranial and extracranialsegments of the internal carotid artery, basilar artery, and bilateral vertebralartery occlusion) confirmed by imaging (including CTA or MRA).

2. Scheduled for endovascular treatment.

3. Intracranial hemorrhage confirmed by imaging post-thrombolysis.

4. Definite or suspected cardioembolic stroke.

5. Stroke caused by other determined causes, including moyamoya disease, arterydissection, arteritis, etc.

6. Pre-stroke mRS score > 1.

7. Severe consciousness disturbance with NIHSS item 1a (level of consciousness) ≥ 2points.

8. Post-thrombolysis imaging indicates an infarct area larger than 1/2 responsibleartery supply area.

9. Prior history of stroke events (manifesting as stroke symptoms, includinghemorrhagic stroke and ischemic stroke).

10. Known contraindications for antiplatelet therapy, such as coagulation disorders,systemic bleeding, etc.

11. History of aspirin allergy.

12. Use of antiplatelet or anticoagulant therapy within one week pre-stroke.

13. There is definite anticipation of developing indications for anticoagulant therapyduring the study period (e.g., atrial fibrillation, mechanical heart valve, deepvein thrombosis, pulmonary embolism, antiphospholipid syndrome, hypercoagulablestate).

14. Presence of malignant tumors, chronic hemodialysis, severe renal insufficiency (GFR < 30 ml/min or serum Cr > 220 μmol/L (2.5 mg/dl)), severe hepatic insufficiency (serum ALT > 2 times the upper limit of normal, or serum AST > 2 times the upperlimit of normal), severe heart failure (NYHA class III or IV).

15. Severe non-cardiovascular complications with an expected survival of less than 6months.

16. Unavailability for follow-up.

17. Presence of dementia, psychiatric disorders, or other known neurological conditionsthat complicate follow-up.

18. Current participation in another therapeutic study with ongoing treatment andfollow-up.

19. Other conditions that are not suitable for participation in this study as determinedby the investigator.