Stroke is a leading cause of long-term disability and death in developed countries. The primary medical strategy for secondary prevention of stroke is antiplatelet therapy. Although the clinical value of acetylsalicylic acid (ASA) is well recognised for preventing secondary stroke, several questions remain. What is the optimal dose of ASA to prevent stroke? Would combining ASA with another antiplatelet drug increase efficacy? Do new agents currently under development offer additional benefits? Many of the recent clinical trials address these questions. This review article summarises the results of these trials in the context of evolving strategies for stroke prevention, including the management of recurrent transient ischaemic attacks (TIAs), side-effects of ASA, and economic issues.