Recurrent ischemic stroke risk after transient ischemic attack was underestimated by most of epidemiological studies due to the widespread use of very different and sometimes restrictive definitions for recurrent stroke instead of a standard definition, making it difficult to assess the benefit of early prevention of recurrence. Knowing that early intervention by treatment with aspirin reduced fatal recurrent stroke and proved to be cost effective by reducing hospital admission, it was worthwhile studying the pharmacogenetics association as well as biological risk factors of aspirin intolerance for patients with recurrent ischemic stroke. Accordingly, our primary outcome was to investigate the association of (Rs1057910) polymorphism as well as other factors such as diabetes, hypertension and smoking with aspirin intolerance for these patients. The secondary outcome was to study the correlation between TNF-alpha as an inflammatory mediator and the prognosis of ischemic stroke for these patients. Our results showed that although smoking and heterozygous A/C of Rs1057910 still have a higher prevalence however statistically insignificant risk for ischemic stroke recurrence compared with other risk factors; OR1.69 and 1.9, 95%CI (0.471–1.695) and (0.321–11.257) respectively. Also, our results suggest that there is a borderline statistically significant correlation between recurrent stroke prognosis and TNF alpha (p = 0.043). Conclusion: This study failed to detect association of Rs1057910 variant of gene with preventive aspirin for patients with ischemic stroke. However, a somehow significant association was detected between ischemic stroke prognosis and TNF- α as an inflammatory marker. Further research investigations on larger sample size population are encouraged.