Introduction Ischemic stroke can occur due to disruption of blood and oxygen supply to brain tissue. White blood cells and platelets play an important role in the pathogenesis of ischemic stroke. Several studies have concluded that the lower the platelet count and the higher the number of white blood cells in ischemic stroke patients will result in a more severe stroke and had worsen prognosis. Platelet and white blood cells counts can be converted into Platelet-to-White Blood Cell Ratio (PWR) which is a comparison between the number of platelets and white blood cells, so the higher PWR will provide better clinical outcomes. Here, we examined correlation between PWR and clinical outcome in acute ischemic stroke using NIHSS tools. Method This research method was a retrospective analytic from 503 medical records of ischemic stroke patients from January 2015 to December 2017. Ischemic stroke divided into 2 groups: cardioembolic stroke and atherothrombotic stroke based on medical records. We calculated PWR and National Institute of Health Stroke Scale (NIHSS) for assessing clinical outcome. Statistical significance calculated with Spearman rank test, ANOVA, and multiple logistic regression. Results A total of 391 research subjects consisting of 213 females (54.5%) and 178 males (45.5%). The mean age of 57.14 years, and 82% subjects had hypertension as risk factor. Mean PWR of atherothrombotic stroke subjects were higher than cardioembolic stroke (33.02 vs 26.73) but had lower mean of NIHSS (5.81 vs 10.31) and had strong negative significant correlation between PWR and NIHSS (r = -0.9603; p < 0.001). From logistic regression, we found that PWR and platelet was statistically significance correlate with NIHSS (p < 0.05). The coefficient if PWR is the highest (absolute value) among other independent variables.It shows that PWR has positive effect on clinical outcome using NIHSS tools in acute ischemic stroke patients. Conclusion Cardioembolic stroke had higher PWR compared with atherothrombotic stroke. PWR had a strong correlation with NIHSS. The higher PWR will provide higher NIHSS and PWR has positive effect on clinical outcome using NIHSS tools in acute ischemic stroke patients.