Background: International guidelines recommend oral anticoagulation in patients with atrial fibrillation according to their level of stroke risk. This study aimed to determine oral anticoagulation use in atrial fibrillation patients with recent ischemic stroke and examine factors that impact such management in China. Methods: Among the patients with acute ischemic stroke (n=4782) from the China QUality Evaluation of Stroke Care and Treatment study, a multicenter, prospective, 62-hospital registry in China, there were 499 (10%) (mean age 70±12years, 49% female) with documented atrial fibrillation with outcome data over 12months of follow-up. Logistic regression analysis was used to identify the independent predictors of oral anticoagulation use in these patients. Results: Of the 499 stroke patients with atrial fibrillation, oral anticoagulation use was 20% overall but varied from 8% prestroke and 11% in-hospital (poststroke), to 13% and 10% at three-months and 12months, respectively. Oral anticoagulation use was independently associated with younger age (odds ratio 0·95, 95% confidence interval 0·93-0·97, P<0·001), nonmanual occupation (odds ratio 0·44, 95% confidence interval 0·25-0·80, P=0·006), and less cardiovascular risk factors (odds ratio 0·81, 95% confidence interval 0·68-0·96, P=0·02). Conclusions: These data indicate oral anticoagulation use is lower in stroke patients with atrial fibrillation in China than that in Western countries, being applied more often in those of younger age, nonmanual occupation, and having less cardiovascular risk factors.