OBJECTIVES:  To describe the secondary prevention medication use of patients with non-cardioembolic ischemic stroke in Beijing, China. METHODS: This was a retrospective cohort study using Beijing Urban Employee Basic Medical Insurance database. Patients (≥18 years old) hospitalized with a primary diagnosis of non-cardioembolic ischemic stroke (index event) between Oct.01 2012 and Dec.31 2014 were included. High-risk patients were further identified by Essen Score ≥ 3, with absence of smoking information in the database. The period from 2 years prior to index date to Dec 31 2015 or death (whichever comes first) was observed to analyse baseline characteristics and secondary prevention medication usage. RESULTS:  In total 33,730 patients were included in the study, with mean age of 67.1 years and 68.7% male. Among which, 59.1% were high-risk patients. During the index hospitalization, 85.4% of the total patients received antiplatelet medication, 83.7% of patients combined with hyperlipidaemia received lipid-lowering medication, 78.2% of those with hypertensive received antihypertensive medication, and 70.1% of those with diabetic patients received antidiabetic medication. The percentages decreased to 43.1%, 44.1%, 50.6% and 43.4% during 10-12 month after index hospitalization, respectively. Similar trend was found among the high-risk patients: 84.3% with antiplatelet medication, 81.8% with lipid-lowering medication, 79.6% with antihypertensive and 68.6% with antidiabetic medication at index hospitalization; but decreased to 42.7%, 41.7%, 49.0% and 41.2% during 10-12 month after index hospitalization, respectively. Among the patients treated with antiplatelet therapy at index hospitalization, 50.1% used aspirin, 23% clopidogrel and aspirin, and 19.2% clopidogrel. 39.9% of those patients experienced antiplatelet therapy modification during follow-up period. CONCLUSIONS:  More than half of the included stroke patients were high-risk patients. The secondary prevention medication usage was suboptimal in the clinical practice even for high-risk patients. Efficient intervention is needed to improve the adherence to guideline.