Approximately 5.7 million people died from stroke in 2005 [1]. According to World Health Organization estimates, figures are predicted to increase to 23 million first-ever strokes, 77 million stroke survivors, 61 million disability adjusted life years (DALYs) and 7.8 million deaths in the next 20 years [2]. Heart disease and stroke are leading causes of DALYs lost and deaths worldwide [3]. Over 70 % of ischemic strokes are first events, which makes primary prevention immensely important. The treatments for acute ischemic stroke have emerged during the last decade and there is growing evidence of efficacy and importance of secondary prevention. We foresee that patients at high risk of vascular events could reduce their risk by 75 to 80 % through optimal prevention strategies including a combination of lifestyle changes and medical therapy [4]. In this review, we will focus on the aspects of antithrombotic treatment of ischemic stroke (IS) in the primary and secondary prevention.