Objective To investigate the efficacy and safety of intravenous thrombolysis in patients with acute ischemic stroke manifested as repeated transient ischemic attack (TIA).Methods A total of 111 acute ischemic stroke inpatients with repeated TIA who were admitted to Neurovascular Center of our hospital from Aug. 1, 2013 to Sep. 11, 2019 were retrospectively included. The patients were divided into intravenous thrombolysis group (57 cases) and non-intravenous thrombolysis group (54 cases treated with standard antiplatelet drugs alone). National Institutes of Health stroke scale (NIHSS) score 7 d after treatment was used to evaluate the early efficacy (NIHSS score decreased by ≥ 0 indicated effective). Modified Rankin scale (mRS) score 90 d after treatment was used to evaluated the long-term prognosis (mRS score ≤ 2 indicated good prognosis). Heidelberg classification was used to evaluate the hemorrhagic transformation after treatment.Results There were no significant differences in age, gender, hypertension, diabetes mellitus, ABCD2 (age, blood pressure, clinical features, duration of symptoms, diabetes mellitus) score, or TIA times and NIHSS score before treatment between the 2 groups (all P>0.05). After treatment, the recurrence times of TIA was significantly lower in the intravenous thrombolysis group than that in the non-intravenous thrombolysis group (0[0, 2] vs 0[0, 18], P=0.028). The proportion of patients whose NIHSS score decreased by ≥ 0 7 d after treatment was significantly higher in the intravenous thrombolysis group than that in the non-intravenous thrombolysis group (98.2%[56/57] vs 90.7%[49/54], P<0.001). There were no significant differences in the positive rate of magnetic resonance diffusion weighted imaging (DWI) 7 d after treatment, good prognosis rate 90 d after treatment or incidence of asymptomatic intracranial hemorrhage between the 2 groups (all P>0.05). No symptomatic intracranial hemorrhage or death occurred in the 2 groups.Conclusion Intravenous thrombolysis can improve the early neurological function of patients with acute ischemic stroke manifested as repeated TIA, and the long-term efficacy is similar to that of standard drug treatment.