OBJECTIVES: Antiplatelet (AP) therapies are the recommended treatment for prevention of recurrent stroke. However, bleeding is a significant risk with any AP therapy. Data on the real-world use of AP therapies in the prevention of recurrent stroke is lacking. This study evaluated current AP treatment patterns in a real-world setting following an initial ischemic stroke (IS) or transient ischemic attack (TIA). METHODS: This retrospective observational study utilized data from the Optum Clinformatics Extended Data Mart – Date of Death (DOD) database from 1/1/2013-12/31/2019. Adult patients with a hospitalization with primary diagnosis for IS or TIA (index event) and imputed NIH Stroke Scale/Score (NIHSS) score of the index event ≤7 were included. Patients with a history of atrial fibrillation, stroke, or oral anticoagulant use before the index event were excluded. Prescription AP treatment patterns were assessed within 90 days following the index event. RESULTS: A total of 154,273 patients were included in the study. The mean age of the study patients was 69.6 (12.9) years and 55.7% were female. 41,622 (27.0%) patients received prescribed AP therapy within 90 days of the index event. Of patients receiving AP therapy, 91.1%, 7.9% and 1.0% were treated with single, dual and multiple AP therapy, respectively. The most commonly used AP therapies were clopidogrel (n=32,442), followed by aspirin (n=4,391) and aspirin plus clopidogrel (n=1,612). The majority of patients continued their first AP therapy beyond 90 days following the index event. 8,603 (17.2%) patients discontinued their first AP therapy and initiated a second line of AP therapy within 90 days of the index event. CONCLUSIONS: Many patients at risk of recurrent stroke were not receiving or discontinued prescribed antiplatelet therapy within 90 days following hospitalization for IS or TIA. Further analyses are needed to evaluate clinical outcomes for this patient population.