About 80% of strokes have ischemic origin. Therapeutical options of acute stroke are still limited and the occurrence of recurrent strokes is remarkably high. Consequently, the adequate stroke prevention has a high importance. The two main components of prevention are the inhibition of platelet aggregation and the anticoagulant therapy. Results of multicenter drug trials showed that antiaggregation therapy can reduce the risk of recurrent stroke by ca. 25%. Acetylsalicylate has been used for stroke prevention for decades. Nowadays, there is a broad spectrum of available platelet aggregation inhibitors. The efficacy of these new drugs is higher than that of acetylsalicylate. According to recent therapeutical guidelines, the antiaggregation therapy of patients with non-cardiometabolic stroke should be optimized individually. The most frequent cause of cardiogenic stroke is atrial fibrillation. The importance of anticoagulation therapy has been proved by large multicenter studies. Absolute therapeutical indications are the elder age, additional risk factors, previous stroke. Therapeutical guidelines in other cardiological disorders associated with high risks for stroke need further drug trials. Fifty years after the introduction of warfarin, in the last years new direct thrombin inhibitors have been developed. These drugs have the same efficacy as warfarin but they are a more safety and have more simply therapeutical administration.