الفهرس 
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Abstract
Stroke has been considered the second-leading cause of death worldwide behind heart disease in 2015 and is a common cause of permanent disability (Valery L Feigin, 2017) Studies have reported a 30-day recurrence rate of 1.1 to 15 % after stroke (Mohan et al., 2011)and as high as 17% after a TIA (Giles and Rothwell, 2007). Therefore, early initiation of antiplatelet agents in ischemic stroke and TIA patients is important to prevent stroke recurrence and is tracked as a quality measure by organizations that accredit stroke centers (Fonarow et al., 2010). Although Intravenous thrombolysis with alteplase is the mainstay medical treatment for acute ischemic stroke (AIS) (Disorders and Medicine, 1995) most patients with ischemic stroke not receiving it as most of patients presented to the emergency department beyond the approved time window for thrombolytic or other revascularization therapies due to lack of health education about signs and symptoms of stroke beside their high cost. So no available treatment for patient with ischemic non cardio embolic stroke except anti- platelets. In addition, those who present with rapidly resolving deficit or low National Institutes of Health stroke scale (NIHSS) score are generally not considered for thrombolytic treatment, although approximately one third of them may be at high risk for neurological deterioration and recurrent vascular events (Barber et al., 2001). This study aimed at determining the safety and the efficacy of immediate antiplatelet therapy (that is, started as soon as possible within the first 24hr of the onset of symptoms) in reducing the risk of early recurrent stroke within three months after onset of ischemic stroke. This study will help us in our neurological department to build up guidelines in treatment of cases of acute ischemic stroke that present to our neurological department in Assiut University Hospital within the first 24 hours of onset of symptoms of ischemic stroke among Egyptians. If the study proven which of these drugs (aspirin alone, clopidogrel alone, or combination of them) is most efficacious and safe. This would present a cost effective treatment option for the thousands of Egyptian patients with ischemic stroke not eligible for revascularization therapies The study allocated randomly 315 patients divided into three groups and assigned in a 1:1:1 ratio to receive either clopidogrel plus aspirin or placebo plus aspirin or placebo plus clopidogrel based on serial number of patients using spss program. Our study concluded that patients with acute mild to severe ischemic stroke who received a combination of clopidogrel and aspirin for 90 days had insignificant lower risk of recurrent ischemic stroke, myocardial infarction, or death from ischemic vascular causes but had a significant higher risk of sever hemorrhage than patients who received aspirin or clopidogrel alone during the 90-day study period.