The Indian data comparing the efficacy and safety outcomes of tenecteplase and alteplase in acute ischemic stroke is scarce. We aimed to compare the outcomes of two agents in an Indian population. Methods: TENVALT study was a single centre, retrospective study. Patients aged 18 years or older with acute ischemic stroke were included in this study if they presented within 3 hours of symptom onset and had a deficit with National Institute of Health Stroke Scale (NIHSS) score > 4, had a modified Rankin score (mRS) of 2 or less before the stroke onset and had no evidence of hemorrhage on non-contrast computed tomography of brain. A good functional recovery (mRS score of 0-2) at the end of three months was defined as the primary efficacy outcome. The development of symptomatic intracerebral hemorrhage was considered as the primary safety outcome. Results: A total of 120 patients (alteplase, n=65; tenecteplase, n=55) underwent stroke thrombolysis during this study. The mean age of the presentation in tenecteplase group was 66.6 years and in alteplase group was 62.5 years. Most of the study subjects were males in both the groups (tenecteplase, 78.2%; alteplase, 61.5%). Hypertension was the most common comorbidity in both the groups (tenecteplase, 67.3%; alteplase, 76.9%). Median mRS score at 3 months of follow up was 2 in tenecteplase and 1 in alteplase group; however, the difference between the total number of patients having good functional recovery (mRS 0-2) in the two groups was not statistically significant (tenecteplase 74.5 vs alteplase 87.7%, P=0.09). The total number of patients who had symptomatic intracranial hemorrhage was comparable between the two groups (tenecteplase, 5.5%; alteplase, 6.2%).