A Study of the Efficacy and Safety of Alteplase in Participants With Mild Stroke

Inclusion Criteria:

- Mild ischemic stroke defined as the most recent pre-treatment NIHSS score of less than
or equal to(
- Study treatment initiated within 3 hours of last time participant seen normal

Exclusion Criteria:

- Computed tomography (CT) or magnetic resonance imaging (MRI) findings of one of the
following:

1. CT with clear large hypodensity that is greater than (>) one-third middle
cerebral artery (MCA) territory (or >100 cubic centimeter [cc] if not in MCA
territory)

2. MRI with clear large hyperintensity on concurrent diffusion-weighted (DW) and
fluid-attenuated inversion recovery (FLAIR) that is greater than one-third MCA
territory (or greater than 100 cc if not in MCA territory),

3. Imaging lesion consistent with acute hemorrhage, or

4. Evidence of intraparenchymal tumor

- Disability prior to the presenting stroke

- Standard contraindications to IV alteplase within 3 hours of symptom onset, including:

1. Head trauma, myocardial infarction, or previous stroke within the previous 3
months

2. Gastrointestinal or urinary tract hemorrhage within the previous 21 days

3. Major surgery within the previous 14 days

4. Arterial puncture at non-compressible site within the previous 7 days

5. Any history of ICH with the exception of those less than (<) 5 chronic
microbleeds on MRI

6. Elevated blood pressure defined by systolic blood pressure >185 millimeters of
mercury (mm Hg) or diastolic blood pressure >110 mm Hg, or treatments requiring
aggressive measures to achieve acceptable levels

7. Treatment with unfractioned heparin within past 48 hours and activated partial
thromboplastin time outside normal range

8. Blood glucose <50 milligrams per deciliter (mg/dL)

9. International normalized ratio >1.7

10. Platelet count <100,000 per cubic millimeter (/mm^3)

11. Treatment with a direct thrombin inhibitor (dabigatran) or a factor Xa inhibitor
(apixaban, rivaroxaban, edoxaban) within the last 48 hours

- Allergic reaction to study drug, aspirin, or nonsteroidal anti-inflammatory drugs
(NSAIDs)

- Females of childbearing age who are known to be pregnant and/or lactating

- Inability to swallow, which would prevent oral intake of aspirin or aspirin placebo
tablet

- Other serious, advanced, or terminal illness that would confound the clinical outcome
at 90 days

- Current or recent (within 3 months) participation in another investigational drug
treatment protocol

- Anticipated inability to obtain 3-month follow-up assessments

- Previous enrollment in PRISMS

- Any other condition deemed by the investigator that would pose hazard to the
participant with alteplase treatment