Abstract：Objective：To observe the effects of Huoxue Tongmai Capsules combined with conventional treatment on stroke recurrence rate，neurological function，and safety in elderly patients with ischemic stroke. Methods：A total of 80 elderly patients with ischemic stroke treated at the Affiliated Hospital of Shaoxing University from March 2024 to April 2025 were selected and randomly divided into the control group and the observation group using the random number table method，with 40 cases in each group. Both groups received conventional treatments including control of intracranial pressure，oxygen therapy，inhibition of platelet aggregation，plaque stabilization，cerebral nutrition，and neuroprotection. The control group additionally received conventional secondary prevention medication with Aspirin Enteric-Coated Tablets orally，while the observation group received Huoxue Tongmai Capsules orally in addition to the treatment given to the control group. Both groups were treated continuously for six months. Changes in the National Institutes of Health Stroke Scale （NIHSS） score， Activities of Daily Living （ADL） score， and traditional Chinese medicine syndrome scores were compared between the two groups before and after treatment. Laboratory parameters including blood platelet count （BPC），alanine aminotransferase （ALT），low-density lipoprotein cholesterol （LDL-C）， prothrombin time （PT）， and D-dimer （DD） were measured. The stroke recurrence rate and incidence of bleeding events within six months were recorded. Results： After treatment， the scores of NIHSS and traditional Chinese medicine syndrome in the control group decreased compared with those before treatment （P＜0.05）. After treatment， the scores of NIHSS， and traditional Chinese medicine syndrome in the observation group decreased compared with those before treatment， while the ADL sore increased （P＜0.05）； moreover， the traditional Chinese medicine syndrome score in the observation group was lower than that in the control group （P＜0.05）. After treatment，there were no statistically significant differences between the two groups in BPC，ALT，LDL-C，PT，or DD levels （P＞0.05）. After treatment，LDL-C levels in both groups decreased compared with those before treatment （P＜0.05）；ALT levels in the observation group increased compared with those before treatment （P＜0.05）. Within six months of treatment， the stroke recurrence rate in the observation group was 2.50%， lower than that of 20.00% in the control group （P＜ 0.05）. No bleeding events occurred in either group. Conclusion：Huoxue Tongmai Capsules combined with Aspirin can reduce the risk of stroke recurrence and improve activities of daily living in elderly patients with ischemic stroke without increasing the risk of bleeding，demonstrating good safety. It may serve as an alternative option for secondary prevention of ischemic stroke in the elderly.