In Asia, there is limited information regarding symptomatic intracerebral hemorrhage (ICH) in patients treated with intravenous (iv) recombinant tissue plasminogen activator (rtPA). The aim of this study was to identify independent factors associated with symptomatic ICH following iv rtPA. The study included 192 patients with acute ischemic stroke who were treated with iv rtPA. Baseline characteristics were compared between patients with or without ICH. Symptomatic ICH occurred in 5.7% of patients and asymptomatic ICH in 13.0% of patients. An international normalized ratio (INR) ≥1.0 (odds ratio [OR] = 4.89, p = 0.036), atrial fibrillation (OR = 7.21, p = 0.009) and blood glucose concentration >8.325 mmol/L (OR = 9.00, p = 0.004), were independent risk factors for symptomatic ICH. Atrial fibrillation (OR = 3.56, p = 0.012) and severe stroke (National Institutes of Health Stroke Scale ≥15; OR = 8.94, p < 0.001) were independent risk factors for asymptomatic ICH. The prevalence of symptomatic ICH following iv rtPA in Thai patients was comparable to previous studies. © 2012 Elsevier Ltd. All rights reserved.