Abstract: Objective：To investigate the efficacy and safety of intravenous thrombolytic therapy with low-dose (0.6 mg/kg) or standard-dose (0.9 mg/kg) alteplase in the treatment of elderly patients (age＞80 years) with acute ischemic stroke. Methods：Fourty elderly patients with acute ischemic stroke within 3 hours after onset were randomly divided into two groups: 21 patients in the low-dose alteplase group and 19 patients in the standard-dose alteplase group. The general situation, National Institute of Health stroke scale (NIHSS) scores, bleeding events, modified Rankin Scale (mRS) score after 90 days of morbidity, and 90-day mortality were compared between the two groups. Results：There was no significant difference in general clinical data, baseline NIHSS score, and 24 h and 7 d NIHSS score between low-dose group and standard-dose group. And no significant difference was found in the incidence of intracranial hemorrhage, the 90-day mortality, and the ratio of 90-day mRS score of 0-2 between the two groups. Conclusions：Low-dose alteplase has similar efficacy and safety profile compared with standard-dose alteplase in elderly patients with acute ischemic stroke.