Objective To explore the categories of different decision-making psychological characteristics of thrombolytic agent decision makers in acute ischemic stroke and to analyze the influencing factors so as to provide reference for the development of thrombolytic decision aid strategies. Methods Acute ischemic stroke patients and their agent decision makers attending the emergency department of a comprehensive tertiary hospital in Zhengzhou City,Henan Province,from September 2019 to December 2021 were recruited as participants. General Information Questionnaire,Decision-making Participation Expectancy Scale,Decision Dilemma Scale,and the Wake Forest Physician Trust Scale were adopted to collect relevant information from participants within 48 hours of their admission. The optimal number of clusters was determined using sum of the squared errors and silhouette coefficients,the final clustering was completed using K-means cluster analysis,and the influencing factors were analyzed by unordered multicategorical logistic regression. Results Acute ischemic stroke thrombolytic agent decision makers were classified in to three types namely “low trust-passive-decision delay”(9.1%),“moderate trust-cooperative-decision conflict”(42.6%),and “very trust-cooperative-decision effective”(48.3%). Factors influencing the three categories included gender of the decision maker,number of decision makers,education level of decision makers,knowledge of the decision maker about stroke,whether the decision maker lived with the patient,patient’s income before the onset of stroke,NIHSS score,and time to onset of stroke(all P<0.05). Conclusion The psychological characteristics of decision makers differ among thrombolysis agents. Healthcare professionals should provide individualized decision aids to improve the efficiency of thrombolysis decision making,accelerate the process of informed consent for thrombolysis,and strive for valuable time to maintain patients’ neurological function.