Objective: To investigate the role and value of thromboelastography (TEG) in the clinical evaluation of intravenous thrombolysis in elderly patients with cerebral infarction. Methods: This study selected 33 patients who underwent intravenous thrombolysis within the 3–4.5-hour treatment window as the intravenous thrombolysis group, and included 202 patients who received conventional drug therapy. All patients underwent thromboelastography evaluation and were divided into three age groups: 60–70 years old, 70–80 years old, and 80–90 years old. Thromboelastography indicators were compared among different groups. Results: Compared to pre-treatment values, the R and K values significantly increased, while the α angle and CI significantly decreased in the 60–70 years old, 70–80 years old, and 80–90 years old groups, with statistical significance (P < 0.05). Compared to pre-treatment values, the MA value in the intravenous thrombolysis group significantly decreased, with statistical significance (P < 0.05). Within the intravenous thrombolysis group, the R and K values in the 70–80 years old group were longer than those in the 60–70 years old group and the conventional drug therapy group, while the CI was higher than in the 60–70 years old group and the conventional drug therapy group. The α angle and MA values were lower than in the 60–70 years old group and the conventional drug therapy group, with statistical significance (P < 0.05). Conclusion: Thromboelastography can be used to evaluate the clinical outcomes of intravenous thrombolysis in elderly patients with cerebral infarction and can provide an optimized treatment plan for intravenous thrombolysis in elderly patients with acute cerebral infarction, making it worthy of clinical promotion and application.