Int J Stroke 2015; 10(5) e49. We have previously reported an observational, population-based, retrospective study of thrombolysis for acute stroke in South Australia (SA) demonstrating marked geographical disparities in care (1). We subsequently undertook a retrospective casenote review of acute stroke outcomes in SA during the three-year period from 2008 to 2010, with ethics approval from the SA Health Department. Our main outcome measures were total thrombolysis rate, incidence of intracranial haemorrhage (parenchymal haematoma-2) and thrombolysis rates related to distance from an acute stroke unit. Our data source was statewide hospital electronic repository records of patients given thrombolytic therapy for ischaemic stroke in the four major public and teaching hospitals in SA during the period 1/1/2008–31/12/2010. Case notes of thrombolyzed stroke patients were examined (JML and AWM) for time of symptom onset, time of arrival to hospital, time of thrombolysis administration and postcode. All imaging was reviewed by a neuroradiologist (WKC). We identified 6510 ischaemic stroke patients, with 1931, 2236 and 2343 strokes occurring during 2008, 2009 and 2010, respectively. Thrombolytic therapy was administered to 293 of these patients (4·5%); mean age 72·4 years (standard deviation: 13·8 years) and 52·2% were male. There was no significant variation in patient age and gender by year (P = 0·84 and P = 0·72, respectively); 96·2% of patients received thrombolytic therapy within three-hours of arrival. The thrombolysis rate increased significantly (P < 0·008) over the three-year period (3·4%, 4·6% and 5·3%, respectively ; 4·5% overall). Although rates remained inversely proportional to the distance from an acute stroke unit (P < 0·0001), disparities were reduced. The intracranial haemorrhage rate remained stable (11·9% overall) and did not differ according to year (P = 0·40), facility (P = 0·58) or distance from the nearest stroke centre (P = 0·37). Leyden et al. estimated thrombolysis rates in SA to be low (<2%) in the period 2007–2009 compared to other regions in the world (1). We report that our thrombolysis rates in 2009 and 2010 have more than doubled (to 4·6% and 5·3%, respectively) and are similar to those of other international studies (2–4). Adeoye et al. reported that thrombolysis rates approximately doubled in the USA between 2005 and 2009 (2); a South African hospital study found their rates more than doubled between 2005 and 2010 (3), while a German study showed thrombolysis rates increased more than threefold between 2003 and 2009 (4). During the time period considered, several SA Health initiatives were implemented, including the establishment of dedicated stroke units and introduction of stroke nurses (5). Subsequently the Stroke Network initiated the South Australian Ambulance Service Hospital Bypass Protocol, which may have a further impact on thrombolysis rates and requires confirmation with future studies.