Objective To explore the risk factors of hemorrhagic transformation (HT) in elderly patients with acute ischemic stroke (AIS) after intravenous thrombolysis. Methods The clinical data of 326 elderly AIS patients undergoing intravenous thrombolysis in our department from January 2016 to March 2019 were retrospectively collected. They were divided into HT group (n=51) and non-HT group (n=275) according to whether HT occurred after intravenous thrombolysis. SPSS statistics 22.0 was used for data analysis. Univariate analysis and multivariate logistic regression were used to analyze the risk factors of HT in elderly patients with AIS after intravenous thrombolysis. Results Univariate analysis showed that atrial fibrillation, positive urinary protein, systolic blood pressure 24h after thrombolysis, blood glucose, international standardized ratio, National Institutes of Health Stroke Scale (NIHSS) score before thrombolysis, NIHSS score 24h after thrombolysis and the time from onset to thrombolysis >3h were significantly higher in the HT group than the non-HT group (P<0.05). Multivariate logistic regression analysis indicated that systolic blood pressure (OR=1.935, 95%CI 1.226-4.162), blood glucose (OR=2.240,95%CI 1.638-5.237), NIHSS score before thrombolysis (OR=2.435, 95%CI 1.805-5.726) and 24h after thrombolysis (OR=3.381,95%CI 2.216-7.250) and thrombolytic time >3h (OR=2.703,95%CI 1.914-6.116) were independent risk factors for HT after intravenous thrombolysis in elderly AIS patients (P<0.05). Conclusion Systolic blood pressure 24h after thrombolysis, blood glucose, NIHSS scores before and 24h after thrombolysis and time from onset to thrombolysis >3h are independent risk factors for HT in elderly patients with AIS after intravenous thrombolysis, and these indicators can provide reference for clinical thrombolysis treatment.