Objective To investigate the clinical value of von Willebrand factor ristocetin cofactor activity (VWF:Rco) in assessing the prognosis and 2-years’ prognosis of cerebral infarction. Methods 61 patients with cerebral infarction (CIP) and 104 normal controls (CTL) were enrolled from July 2014 to February 2015 in our hospital, respectively. VWF:Rco was measured, then the modified Barthel index and Rankin scoring were used for evaluating the followed up 2-years’ prognosis of activities of daily life and neurological recovery. Results CIP had higher VWF:Rco than those in CTL (59.15% vs. 224.0%，P＜0.0001), and VWF:Rco was positively correlated with VWF antigen (r=0.996, P＜0.0001); VWF:Rco in CIP with different age group had significant differences and increased with age; ultra-large VWF level in CIP was also increased. VWF:Rco was positively correlated with high-sensitivity C-reactive protein and the recovery of neurological function in the firstly diagnosed CIP (r=0.382, P=0.002; r=0.269, P=0.036, respectively), while negatively correlated with activities of daily life (r=-0.293, P=0.022). Besides, the higher VWF:Rco, the poorer prognosis. Conclusion CIP had significantly higher VWF:Rco than those in CTL, and VWF:Rco is associated with the severity of cerebral infarction. VWF:Rco can be used as a marker for value the prognosis of cerebral infarction. The higher VWF:Rco level, the poorer prognosis.