Aspirin Combined With Clopidogrel Versus Intravenous Alteplase for Acute Minor Stroke

Inclusion criteria

• Aged 40-80 years.
• Diagnosed with acute ischemic stroke, NIHSS ≤ 5 and single item score ≤ 1 for vision, language, single limb, and no impairment of consciousness.
• Time from symptoms onset to randomization within 4.5 hours; the onset time refers to the "Last Known Normal" (LKN).
• Absence of large vessel occlusion on CTA.
• Pre-stroke mRS ≤ 1.
• Signed informed consent.

Exclusion criteria

• Clinically confirmed valvular or non-valvular atrial fibrillation requiring anticoagulation therapy.
• Intracranial hemorrhage or subarachnoid hemorrhage suggested by CT scan.
• Acute coronary syndrome suggested by Electrocardiogram.
• History of gastrointestinal bleeding.
• Planned sequential IVT or endovascular treatment.
• History of allergy to aspirin, clopidogrel, and/or alteplase.
• Systolic blood pressure exceeding 185 mmHg and/or diastolic blood pressure exceeding 110 mmHg despite antihypertensive treatment.
• Blood glucose ≤ 2.7 mmol/L.
• Epileptic seizures during a stroke attack.
• Recent trauma (<15 days).
• Recent intracranial or spinal cord surgery, head trauma, or stroke (<3 months).
• History of intracranial hemorrhage, aneurysm, vascular malformation, or brain tumor.
• Active visceral hemorrhage (<22 days).
• History of anticoagulant use within 24 hours prior to onset.
• Platelets <100,000, PTT > 40 seconds on heparin, or PT > 15 or INR > 1.7, or known bleeding disposition.
• Anticipated life expectancy < 3 months.
• Pregnant or lactating women.
• Participation in other clinical trials.
• Any condition that, in the judgment of the investigator, makes the patient unsuitable for this study or where this study may impose a significant risk to the patient (e.g., inability to understand and/or comply with study procedures and/or follow-up due to psychiatric disorders, cognitive or emotional impairment).