Background: Intravenous thrombolytic therapy is associated with a significant net reduction of disability after acute ischemic stroke. However, information on the benefit–risk profile of thrombolytic therapy in hyperacute ischemic stroke in Bangladeshi people is unavailable at present. The present study was aimed to share the experiences and to determine the predictors of functional outcome of intravenous thrombolytic therapy in a sample of Bangladeshi patients with hyperacute ischemic stroke. Methodology: This retrospective cohort study included patients with hyperacute ischemic stroke aged between 18 and 80 years old who received IV rtPA in the first 4.5 h time window from the onset of stroke symptoms in between December 2019 to August 2021. The patients’ demographics, baseline characteristics and location of stroke were documented. Stroke severity was assessed at time of admission and 24-h after IV rtPA using NIHSS score. All the data were analyzed and correlated with the mRS at 3-months after receiving IV rtPA. Results: Among the thrombolysed patients, around half (45%) of them had severe stroke (NIHSS score >9). Mean admission NIHSS score was 9.45 (±4.56) whereas mean NIHSS score at 24-hours rtPA was 5.71 (±5.92). Functional outcome was assessed by mRS score at 3-months with a mean score of 1.94 (±2.2), where good outcome was found in 70% patients. In the study, age 60 mins (OR, 3.27; 95% CI, 1.06-10.1; p= 0.02) and symptoms onset 3-4.5 hours (OR, 1.58; 95% CI, 1.15- 2.78; p=0.03) were associated with poor functional outcome (mRS, 3-6). Conclusion: Intravenous thrombolytic therapy improves the overall functional outcome among hyperacute ischemic stroke patients. In patients aged less than 70 years, admission NIHSS score