Reduced adherence and compliance to discharge instructions and protocols could significantly influence the ability of any stroke prevention strategy. The goals of this investigation were to evaluate the adherence to secondary prevention strategies within 1 year after ischemic stroke and to identify possible causes of poor compliance with these strategies. Patients who had suffered either acute ischemic stroke or transient ischemic attacks (TIA) were recruited retrospectively through telephone follow-up. The survey included whether the patient was prescribed antithrombotic treatment at discharge and reasons for non-compliance with this prescription both immediately after discharge and 1 year after discharge. Of 472 (73.8%) patients with detailed clinical data who were finally evaluated in this survey, 326 (69.1%) were still under antithrombotic treatment and 172 (36.4%) underwent the same antithrombotic agent as prescribed when discharged. We found that medical insurance and free medical care were able to promote compliance with medication in stroke patients for secondary prevention, while administration of non-aspirin antithrombotic agents or a poor ability for daily activities (Barthel index, BI) had significantly negative effects on medication compliance in stroke patients. Under the conditions of this observational study, adherence to stroke prevention strategies was poor. Income levels, categories of antithrombotic agents and the personal living ability are closely related to compliance. The results suggest that doctors should pay more attention to the secondary prevention of stroke. We suggest that providing stroke patients with detailed instructions for medication usage, physicians could increase the potential that their secondary prevention of stroke could be increased.