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BMS-986177 + clopidogrel is a **combination therapy** under investigation for its safety and efficacy in the prevention of new ischemic stroke or covert brain infarction, particularly in patients with acute ischemic stroke or transient ischemic attack (TIA). **BMS-986177** (milvexian) is an oral, small molecule **Factor XIa inhibitor** that binds reversibly to the active form of Factor XI (FXIa), providing anticoagulation through inhibition of a key coagulation pathway. **Clopidogrel** is a platelet aggregation inhibitor acting through antagonism of the ADP receptor P2Y12. When given together, the combination targets both coagulation and platelet aggregation, aiming for enhanced secondary stroke prevention with a favorable bleeding profile. The therapy is being developed by Bristol Myers Squibb (BMS), with combination regimens including clopidogrel and sometimes aspirin, as explored in Phase 1 and Phase 2 clinical studies for secondary prevention in high-risk post-stroke or TIA populations[3][5][6][8].
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