As many as 300,000 transient ischemic attacks (TIAs) occur in the United States each year, accounting for 0.3% of all Emergency Department visits. An under-recognized and under-treated problem, TIA is associated with up to a 10% risk of subsequent stroke within 7 days and a 25% risk of death at 1 year. Antiplatelet therapy can result in significant reductions in secondary stroke risk. However, nearly 50% of patients with TIA leave the Emergency Department without any medication. This article discusses recent results from major antiplatelet clinical trials in stroke prevention and highlights the need for appropriate and timely initiation of antiplatelet treatment in patients with TIA.