The safety of thrombolytic therapy for acute myocardial infarction in the elderly population has not been clearly established. In a retrospective study we evaluated the efficacy and complications of thrombolytic therapy in the elderly as compared to younger patients. Consecutive 588 patients who received thrombolytic therapy were studied. Clinical data in 136 patients aged above 65 years were compared with 85 patients below 40 years. Cigarette smoking was a common risk factor in the young (46 vs 13; p < 0.0001). Coexistent systemic diseases and conduction system disturbances (28 vs 9; p < 0.05) were common in the older patients, but the incidence of bleeding complications to thrombolytic therapy (6 vs 1; p = NS) was not found to be higher. Ninety percent of the elderly who had cardiogenic shock died. There was no significant difference between the two groups in reinfarction rate (12 vs 15; p = NS) and post-infarct angina (20 vs 20; p = NS). Coronary angiography revealed a higher incidence of multivessel disease in the elderly. To conclude, thrombolytic therapy is safe and effective even in older individuals.