To investigate the clinical characteristics of aspirin resistance (AR) in patients with large-artery atherosclerotic cerebral infarction and to analyze the risk factors for AR. Methods: According to the TOAST classification criteria, 160 patients with acute large-artery atherosclerotic cerebral infarction within 1 week of onset were recruited and treated with oral aspirin (200 mg, once a day) for anti-platelet aggregation. Thromboelastography (TEG) was used to detect platelet inhibition rate after 1 week of treatment, and based on these results, patients were divided into the aspirin sensitive (AS) group and AR group. The clinical data and biochemical indicators of the two groups were compared and analyzed to determine the risk factors of AR. Results: The TEG results showed 42 patients (26.3% ) with AR and 118 patients with AS; the inhibition rates of arachiodonicacid in the two groups were (42.6±18.9)% and (76.3±15.8)% respectively (P<0.05). Univariate analysis showed that, compared with that of the AS group, the proportion of patients with a history of diabetes, smoking, and drinking and the serum Hcy and hs-CRP levels were significantly higher in the AR group (P<0.05). Logistic multivariate analysis showed that diabetic history, smoking and high Hcy levels are independent risk factors of AR. Conclusion: AR may exist in patients with large-artery atherosclerotic cerebral infarction. A history of diabetes and smoking and high Hcy levels are independent risk factors for AR occurrence.