To observe the effect of Tongxinluo Capsule (TXL) on platelet aggregation in patients with cerebral infarction, and to explore its underlying mechanisms. Seventy-four patients with cerebral infarction at the rehabilitation stage were assigned to two groups according to taking or not taking aspirin at hospitalization, the 30 patients in group A were administered with TXL alone and the 44 in group B with TXL combined with aspirin. Platelet aggregation tests induced by adenosine diphosphate, epinephrine, collagen and arachidonic acid were conducted in all patients to evaluate the effect of TXL on platelet aggregation. Platelet aggregation rate induced by adenosine diphosphate and epinephrine decreased after treatment in Group A from 88.5 +/- 4.9 and 92.9 +/- 3.1 to 80.9 +/- 16.5 and 91.8 +/- 4.0 respectively (P <0.05 ); that induced by adenosine diphosphate and arachidonic acid decreased after treatment in Group B from 66.9 +/- 13.5 and 22.7 (13.5 - 32.6) to 62.0 +/- 16.3 and 17.7 (10.2 - 23.7) respectively (P < 0.05 and P < 0.01). Cases of aspirin resistance reduced in Group B from 20 (45%) to 10 (23%), also showing statistical difference (P <0.05). No obvious increase of side effect was found after combined use of TXL with aspirin. TXL has anti-platelet aggregation effect, its mechanism may be related with the inhibition of adenosine diphosphate and arachidonic acid path. It is relatively safe when used in combination with aspirin.