Cinnamon can reduce levels of blood lipids, blood glucose, and inflammation, which are risk factors for ischemic stroke and transient ischemic attack (TIA).The goal of this study was to observe the safety and efficacy of aspirin combined with cinnamon in the treatment of patients with mild stroke or TIA.This pilot study included patients with mild stroke or TIA treated at Guangdong Provincial People's Hospital-Nanhai Hospital between January 2014 and December 2016. The primary end point was recurrent stroke (within 90 days after the first attack; intention-to-treat analysis). The secondary end points included biochemical indices, carotid color Doppler ultrasound, safety indices, and adverse reactions.A total of 122 patients were included, including 62 in the aspirin-cinnamon group (41 men and 21 women; mean age, 62.0 [3.5] years) and 60 in the aspirin-placebo group (40 men and 20 women; mean age, 63.0 [3.2] years). The number of participants with recurrent stroke was two (3.2%) and nine (15.0%) in the aspirin-cinnamon group and the aspirin-placebo group, respectively (P = 0.002). Compared with aspirin-cinnamon, aspirin-placebo rates of unstable plaque and severe vascular stenosis were higher, whereas the rate of mild vascular stenosis with aspirin-cinnamon was higher than with aspirin-placebo (P < 0.05). One case of mild to moderate upper gastrointestinal bleeding in each group was observed.Among patients with TIA or mild ischemic stroke, the combination of cinnamon and aspirin could be superior to aspirin alone for reducing the risk of 90-day recurrent stroke.Copyright © 2022 The Authors. Published by Elsevier Inc. All rights reserved.