Acute ischemic stroke is the most common type of stroke, accounting for 60%-80% of all strokes. The management of acute ischemic stroke emphasizes early diagnosis, early treatment, early rehabilitation and early prevention of recurrence. Under the guidance of the principles of evidence-based medicine, stroke organizations at home and abroad have developed guidelines for the prevention and treatment of cerebrovascular diseases in different countries. Cerebrovascular Disease Group of the Neurology Branch of the Chinese Medical Association has revised the guidelines for the prevention and treatment of acute ischemic stroke in China since 2002 and stressed the importance of antithrombotic therapy. With the deepening of stroke prevention and treatment and the development of medical technology, the understanding of the mechanism of ischemic stroke thrombosis and accurate antiplatelet therapy is increasing, which provides a new opportunity for accurate antithrombotic therapy. In this paper, the form of thrombosis and the latest progress in antithrombotic therapy in acute ischemic stroke are reviewed, which provide therapeutic references for clinical prevention and treatment of acute ischemic stroke.