Objective To study risk factors for cerebral microbleeds (CMBs) in patients with ischemic cerebrovascular disease and the effects of CMBs on antiplatelet monotherapy.Methods We selected 300 patients with acute ischemic cerebrovascular disease who received antiplatelet monotherapy in the department of neurology of our hospital from January to June, 2018. The basic information and results of relevant examinations were collected. The patients were divided into CMB group (176 cases) and non-CMB group (124 cases) according to the results of gradient recalled echo T2^*-weighted imaging. All the patients were given antiplatelet monotherapy. We compared the clinical data and the incidence rates of reinfarction, cerebral hemorrhage, and death within 1 year after treatment between the two groups, and analyzed the risk factors for CMBs and the influence of CMBs on antiplatelet monotherapy.Results Advanced age, hypertension, obesity, a history of stroke, acute cerebral infarction (ACI), and leukoaraiosis were risk factors for CMBs in the patients with ischemic cerebrovascular disease (P<0.05). The incidence of cerebral hemorrhage during antiplatelet monotherapy showed a significant difference between the CMB group and the non-CMB group (14.20% vs 6.45%, P<0.05). The incidence rates of cerebral hemorrhage were 9.18%, 10.64%, and 35.48% for the mild CMB group, moderate CMB group, and severe CMB group, respectively, with a significant difference (P<0.05). There were no significant differences in the incidence rates of recurrent cerebral infarction, cerebral hemorrhage, and death during antiplatelet monotherapy between patients with CMBs at different sites (P>0.05).Conclusions Advanced age, hypertension, obesity, a history of stroke, ACI, and leukoaraiosis are risk factors for the incidence of CMBs in patients with ischemic cerebrovascular disease. CMBs, especially severe CMBs, can increase the risk of cerebral hemorrhage during antiplatelet monotherapy.