OBJECTIVE： To observe the efficacy and safety of clopidogrel combined with aspirin in the treatment of transient ischemic attack in the elderly. METHODS： 90 elderly patients with transient ischemic were randomly divided into observation group （50 cases） and control group （40 cases）. All patients received conventional treatment， statins， low molecular weight dextran and urokinase， etc.， symptomatic treatment was conducted for patients combined with other underlying diseases. Based on it， control group received 100 mg Aspirin enteric-coated tablet， once a day； observation group additionally received 75 mg Clopidogrel bisulfate tablet， once a day. No other antiplatelet drugs were allowed. They treatment for 6 months. Clinical efficacy， platelet function indexes （CD63， CD62p） before and after treatment， recurrence rate and incidence of cerebral stroke after 6 months follow-up in 2 groups were observed， and the incidence of adverse reactions was recorded. RESULTS： The total effective rate in observation group was significantly higher than control group， recurrence rate and incidence of cerebral stroke were significantly lower than control group， the differences were statistically significant （P＜0.05）. After treatment， CD63 and CD62p levels in 2 groups were significantly lower than before， and observation group was lower than control group， the differences were statistically significant （P＜0.05）. And there were no obvious adverse reactions during treatment. CONCLUSIONS： Based on conventional treatment， clopidogrel combined with aspirin shows better efficacy than aspirin alone in the treatment of transient ischemic attack in the elderly， it can reduce the incidence of cerebral stroke and recurrence rate， with good safety.