Background and Purpose-The role of polymorphisms of the platelet glycoprotein (GP) IIb/IIIa receptor in the development of cardiovascular disease has been the subject of intensive research. The aim of this study was to determine the association of the HPA-3 polymorphism of platelet GPIIb with ischemic stroke and subsequent survival and to identify possible interactions of HPA-3 with classic risk factors. Methods-HPA-3 genotype was determined by restriction fragment length polymorphism in 515 patients with ischemic stroke and 423 healthy, age-matched control subjects. Results-There was no significant difference in the genotype distribution of patients and controls, nor was there any difference when patients were subclassified into small-and large-vessel disease. The genotype distribution of the 231 patients subsequently dying during 2.8 years of follow-up (aaϭ45.0%, abϭ46.8%, bbϭ8.2%) was significantly different from that of those still alive (aaϭ37.0%, abϭ48.2%, bbϭ14.8%) (Pϭ0.03). In a Cox regression model, the relative risks for poststroke mortality in patients of aa and ab genotype compared with those of bb genotype were 2.42 (95% CI, 1.24 to 4.71) and 2.13 (95% CI, 1.09 to 4.17), respectively, after we accounted for confounding factors. In addition, significant interactions of HPA-3 with the Pl A polymorphism of GPIIIa (Pϭ0.002) and with fibrinogen (Pϭ0.01) were identified in relation to mortality. Conclusions-HPA-3 is related to poststroke mortality, and the significant interaction of HPA-3 with Pl A and fibrinogen suggests that it may in some way influence the interaction of GPIIb/IIIa with fibrinogen, particularly in the presence of high fibrinogen.