Objective To analyze the efficacy and prognosis of intravenous thrombolysis in patients with acute ischemic stroke, so as to discuss the influence of time management on the thrombolysis outcome. Methods We retrospectively analyzed the clinical data of the 198 acute ischemic stroke patients who received intravenous thrombolysis in Changhai Hospital from Sep. 2013 to Dec. 2015. The patients were divided into two groups according to U. S. National Institutes of Health Stroke Scale (NIHSS) scores 24 h after thrombolysis:effective group and ineffective group. The clinical data of the two groups were compared to indentify the factors influencing the prognosis. The patients were also divided into two groups according to modified Rankin Scale (mRS) after 90 d:good prognosis and poor prognosis groups; the clinical data of the two groups were also analyzed to identify the influencing factors. The differences were compared between the effective group and ineffective group from the onset to different medication periods, so as to evaluate the influence of time management on prognosis. Results The 198 consecutive acute ischemic stroke patients included 74 in the effective group and 124 in the ineffective group. Single-factor analysis indicated that the pre-thrombolysis baseline NIHSS score, time from onset to the beginning of thrombolysis, and history of coronary heart disease were significantly different between the effective group and ineffective group (P<0.01, P<0.05).Logistic regression analysis showed that low baseline NIHSS score before thrombolysis, shorter time from onset to the beginning of thrombolysis, and no history of coronary heart disease were the independent predictors of a good effect. Single-factor analysis of indicated that the age, blood glucose level prior to thrombolysis, history of diabetes mellitus, history of atrial fibrillation, baseline NIHSS score and GCS score prior to thrombolysis, time from onset to the beginning of thrombolysis and history of coronary heart disease were significantly different between the good prognosis group (157 cases) and the poor prognosis group (41 cases) (P<0.01, P<0.05). Logistic regression analysis showed that low baseline NIHSS score before thrombolysis were independent predictors of good prognosis. Concerning the time management, the time periods from onset to the beginning of thrombolysis were significantly different between the ineffective group and effective group (P<0.01), which was mainly caused by the time from the onset to treatment (P<0.01). Conclusion Lower pre-thrombolysis NIHSS score, shorter time from stroke onset to beginning of thrombolysis, no history of coronary heart disease are associated with good short-term efficacy, and lower pre-thrombolysis NIHSS score is the independent factor of good prognosis for acute ischemic stroke. Early treatment may increase the efficacy of intravenous thrombolysis.