Thrombolysis with tissue plasminogen activator (rtPA) is currently used throughout the world in acute ischaemic stroke management. In this review, we will explore the status of our current knowledge about the effects of rtPA on specific rehabilitation domains and highlight some key knowledge gaps.Narrative review of the larger clinical and postmarketing surveillance studies.To date, most of the previous research into rtPA for acute ischaemic stroke has focused on safety and efficacy using general outcome measures and has ceased following patients 90 days after rtPA administration. This research has provided valuable information about the safety and efficacy of rtPA and has facilitated the introduction of rtPA into clinical practice for stroke management. However there is a paucity of knowledge about the long-term recovery patterns of patients post-rtPA, including the effect of rtPA on specific rehabilitation domains and its impact on post-acute service delivery. Furthermore, limited information is available about the effect of rtPA on post-stroke quality of life and participation in society.These knowledge gaps have substantial implications for the long-term management of patients by rehabilitation teams. Increasing our knowledge in these areas may assist us to predict which individuals are most likely to benefit from thrombolysis with rtPA, and enable us to provide optimal rehabilitation programs to maximise functional outcomes and quality of life post-stroke.• Thrombolysis with tissue plasminogen activator (rtPA) is currently used throughout the world in acute ischaemic stroke management. • Previous research into rtPA has focused on largely on safety and efficacy using general outcome measures. • There is a lack of knowledge about the long-term recovery patterns and service requirements of patients post-rtPA, which has important implications for the management of these patients by rehabilitation teams.