A 67-year-old male with prior history of atrial fibrillation was admitted to our center with acute onset of aphasia. He was treated by intravenous thrombolysis. Approximately 2 years later he presented with left-sided weakness, and was again treated with intravenous tissue plasminogen activator (iv-tPA). The patient responded favorably to thrombolytics on both occasions, without significant complications and with satisfactory recovery. Although there is no apparent reason to withhold thrombolysis in stroke patients with prior history of iv-tPA treatment, experience regarding the use of repeated thrombolysis in recurrent stroke is under-reported in the literature. This study, although reflecting experience from a single case, highlights that repeated administration of iv-tPA is well tolerated in stroke patients with late recurrences and previous history of thrombolysis. Blood Coagul Fibrinolysis 21:605-607 (C) 2010 Wolters Kluwer Health vertical bar Lippincott Williams & Wilkins.