【Abstract】 Objective To investigate the effects of elevated neutrophils on hemorrhagic transformation in patients with acute ischemic stroke (AIS) after intravenous thrombolysis. Methods Clinical data were collected from 177 patients who underwent intravenous thrombolysis due to AIS in the Affiliated Hospital of Xuzhou Medical University between January 2017 and March 2019. According to the dichotomy of neutrophil levels (based on a median of 7.1×109/L), 177 patients were divided into two groups: a low neutrophil level group (<7.1×109/L) and a high neutrophil level group (≥7.1×109/L). The baseline data and the changes of hemorrhagice transformation risk after intravenous thrombolysis of the two groups were retrospectively analyzed. Results The incidence of hemorrhage after thrombolysis was higher in the high neutrophil level group than that in the low neutrophil level group (17.0% vs 5.6%, P=0.016). After adjusting for confounders including age, gender, anti‑thrombotic and anticoagulant medication history, previous stroke history and National Institutes of Health Stroke Scale (NIHSS) score, multivariable logistic regression analysis showed that the high level of neutrophil count was an independent risk factor for hemorrhage after intravenous thrombolysis [odds ratio (OR) =3.622, 95% confidence interval (CI) was 1.099‒12.203, P=0.035]. Conclusions Increased neutrophil count is an independent risk factor for hemorrhagic transformation after intravenous thrombolysis in patients with ischemic stroke.