Pediatric arterial ischemic stroke (IS) is an important cause of lifelong disability. Arteriopathies due to trauma and infection are an important underlying cause of childhood arterial ischemic stroke. The secondary prevention of IS should be conducted taking into account the main pathogenetic mechanisms and vascular risk factors. For secondary stroke prevention, the majority of children are treated with either anticoagulation or antiplatelet therapies. This review focuses on the recent international clinical recommendations in secondary stroke prevention based on the results of randomized multicenter clinical studies published by the USA. cardiology association. Experience of anticoagulation or antiplatelet therapies for secondary stroke prevention is insufficient in Russia. Taking into account the available international recommendations is expedient for creation and practical application of the Russian standards for secondary arterial ischemic stroke prevention.