Objective To analyze the factors causing hemorrhagic transformation （HT） after intravenous thrombolysis in patients with acute cerebral infarction （ACI） in plateau area， and to establish and evaluate anomogram model for predicting the risk of HT in individual patients.Methods A total of 162 ACI patients who underwent intravenous thrombolytic therapy with recombinant tissue plasminogen activator （rt-PA） in our hospital from May 2018 to March 2020 were enrolled in this study. The patients were divided into HT group （34 cases） and non-HT group （128 cases）. A logistic regression model was used to analyze the factors causing HT after intravenous thrombolysis. The rms package of R 3.6.3 was used to establish a nomogram model to predict the risk of HT in ACI patients after intravenous thrombolysis. The nomogram model was evaluated using receiver operating characteristic （ROC） curve， calibration curve， and Hosmer-Leme show goodness-of-fit test.Results The logistic regression model showed that the incidence of HT in ACI patients after intravenous thrombolysis was closely related to diabetes mellitus， cerebral infarction area， time from onset to thrombolysis， NIHSS score， platelet， and D-dimer （P<0.05）. The ROC curve showed an area under the curve of 0.831 ［95% confidence interval （CI）： 0.727-0.935］ for predicting HT risk in ACI patients after intravenous thrombolysis. The calibration curve was a straight line with a slope close to 1. The Hosmer-Lemeshow goodness-of-fit test showed χ²=9.761 and P=0.282.Conclusions Based on the above six independent factors， a nomogram model was established to predict the risk of HT in ACI patients after intravenous thrombolysis in plateau area with high discrimination and accuracy.