This trial is testing a new medication called milvexian to see if it can prevent strokes and blood clots as well as an existing drug, apixaban. Apixaban (Eliquis™) was developed by Bristol-Myers Squibb and Pfizer and has been approved for the prevention of stroke in patients with certain heart conditions. The study focuses on patients who are at risk of these serious conditions. Milvexian works by helping to keep the blood flowing smoothly, reducing the chances of dangerous clots forming.