Objective: Although proven stroke secondary prevention medications are available, persistent use is required to be effective. The present study aimed to investigate the degree of secondary prevention medications persistence after acute ischemic stroke (AIS) or transient ischemic attack (TIA), factors influencing persistence and its association with stroke outcomes. Methods: We examined patients with AIS or TIA enrolled in China National Stroke Registry (CNSR) between 2007 and 2008. Three-month persistence was defined as medication continuation between hospital discharge and 3-month postdischarge. Recurrent stroke and modified Rankin scale (mRS)<= 2 at 3-month postdischarge were used as stroke outcomes. Logistic regression was used to adjust for confounders. Results: Totally, 9998 patients were analyzed. At 3 months, 63.6% of patients continued taking all secondary prevention medications prescribed at hospital discharge. Younger age (P=0.05), male gender (P=0.03), present history of hypertension (P<0.001), absent history of atrial fibrillation (P<0.001), pre-stroke independence (P=0.05), index cerebrovascular event of AIS (P=0.005), being treated in an academic hospital (P=0.003), longer hospital stay (P<0.001), and fewer number of class of baseline secondary prevention medications (P<0.001) were identified as determinants for 3-month persistence. 3-month persistence of secondary prevention medications were significantly associated with less recurrent stroke (adjusted OR=0.78, 95% CI=0.67-0.91, P=0.002) and better functional outcome (mRS <= 2) (adjusted OR=1.17, 95% CI=1.04-1.32, P=0.009) at 3-month postdischarge. Discussion: Almost one-third of patients of AIS/TIA had stopped one or more secondary prevention medications by 3-month postdischarge. Further studies on identifying potential barriers and means to improve persistent use of secondary prevention interventions are needed.