Background: Previous clinical studies suggest that intravenous thrombolysis (IVT) with recombinant tissue plasminogen activator benefits stroke patients, but the efficacy of IVT in young stroke patients is not well-studied in China. Objective: We compared the safety and efficacy of IVT with recombinant tissue plasminogen activator between Chinese young stroke patients (18-50 years old) and older patients (51-80 years old). Method: We analyzed data from the Soochow Stroke Registry for 373 stroke patients (18-50 years, n=74 vs. 51-80 years, n=299) who received IVT between May 2009 and January 2016. Main outcomes included symptomatic intracerebral hemorrhage (sICH) within 7 days, and mortality and favorable outcome (modified Rankin scale 0-2) at 3 months. Associations between baseline characteristics and outcomes for the two groups were analyzed by logistic regression. Results: Favorable outcome at 3 months was significantly higher in young adults (adjusted odds ratio 2.09; 95% confidence interval 1.09-3.99, p=0.026). The incidence of sICH and mortality was low for young adults compared with older patients, but there were no statistically significant differences between the two groups. Multivariable analysis showed that baseline National Institutes of Health Stroke Score was associated with favorable outcome (p=0.026) in young adults. Conclusion: Our analysis indicated that young stroke patients treated with IVT had a more favorable outcome without an increased risk of sICH and mortality compared with older patients. We conclude that IVT is safe and at least as beneficial for Chinese young adults with acute ischemic stroke compared with older patients.