Abstract: Objective To investigate the effect of butylphthalide soft capsule combined with dual antiplatelet therapy in elderly patients with acute middle cerebral ischemic stroke. Methods A total of 100 patients with acute middle cerebral artery ischemic stroke were selected as research subjects. The random number table method was used to divide these patients into two groups, with 50 cases per group. The control group was given double antiplatelet therapy, and the observation group was additionally given butylphthalide soft capsule. Curative efficacy of two groups after treatment was compared, and National Institutes of Health Stroke Scale(NIHSS)score, infarct area, the changes of interleukin-6(IL-6), tumor necrosis factor-α(TNF-α), and malondialdehyde(MDA)were compared. Results The total effective rate in the observation group was 94.00%, which was higher than 78.00% in the control group, and the difference was statistically significant(P<0.05). After treatment, the NIHSS score was lower and infarct area was smaller than treatment before, and the observation group was better than the control group, the differences were statistically significant(P<0.05); after treatment, the levels of IL-6, TNF-α, and MDA of the two groups were lower, and the observation group was lower than the control group, and the differences were statistically significant(P<0.05); no serious adverse reactions occurred during the treatment in the two groups. Conclusion Butylphthalide soft capsule combined with dual antiplatelet therapy has obvious efficacy, which can - reduce infarct area, promote the recovery of nerve function, and reduce levels of inflammatory factors.