Objective To investigate the efficacy and safety of low-dose alteplase in the treatment of patients with minor ischemic stroke.Methods A retrospective analysis was performed for the clinical data of 143 patients with minor ischemic stroke ［National Institutes of Health Stroke Scale （NIHSS） score ≤5］ who were admitted to The People’s Hospital of Leshan within 4.5 hours after onset from November 2017 to January 2022， and according to the treatment method， they were divided into low-dose group with 49 patients， standard-dose group with 46 patients， and control group with 48 patients. The patients in the low-dose group received intravenous thrombolysis with alteplase （0.6 mg/kg） within 4.5 hours after onset， and if there was no hemorrhagic transformation after 24 hours， they were given dual anti-platelet therapy for 21 days； the patients in the standard-dose group received intravenous thrombolysis with alteplase （0.9 mg/kg） within 4.5 hours， followed by the same antithrombotic regimen as the low-dose group； the patients in the control group received dual anti-platelet therapy for 21 days immediately after admission. The three groups were compared in terms of the following indicators： the change in NIHSS score at 24 hours and on day 7 compared with the baseline level； NIHSS score at 24 hours and on day 7 and the proportion of patients with good functional outcome， mild disability， and moderate-to-severe disability on day 90； the incidence rate of bleeding events with 36 hours and 7- and 90-day mortality rates.Results The low-dose group and the standard-dose group had a significant reduction in NIHSS score at 24 hours after treatment， and all three groups had a significant reduction in NIHSS score on day 7 compared with the baseline level （P<0.05）. There was no significant difference in NIHSS score at 24 hours between the three groups （P>0.05）. The low-dose group and the standard-dose group had a significantly lower NIHSS score on day 7 than the control group （P<0.05）， while there was no significant difference between the low-dose group and the standard-dose group （P>0.05）. There was no significant difference between the three groups in the proportion of patients with good functional outcome， mild disability， or moderate-to-severe disability on day 90 （P>0.05）. As for safety， there were no significant differences in the incidence rates of various types of bleeding between the low-dose group and the standard-dose group and between the low-dose group and the control group （P>0.05）； the standard-dose group had significantly higher incidence rates of oral hemorrhage and mucocutaneous hemorrhage than the control group （P<0.05）， while there were no significant differences in the incidence rates of other types of bleeding between the two groups （P>0.05）. There were no significant differences in 7- and 90-day mortality rates between the three groups （P>0.05）.Conclusions Low-dose alteplase may accelerate the recovery of neurological symptoms in patients with mild stroke and has similar efficacy to standard-dose alteplase， without significantly increasing the risk of bleeding and death. ［Journal of International Neurology and Neurosurgery, 2022, 49(6): 7-12］