To evaluate the relation of serum uric acid levels on admission with short-term clinical outcome and hemorrhagic transformation (HT) in patients with acute ischemic stroke treated with thrombolysis. A total of 230 acute ischemic stroke patients treated with thrombolysis in our stroke unit from 2010 to 2013 were included. Demographics, disease severity, the uric acid levels on admission and hemorrhagic transformation were prospectively collected. At 90 days, the scores of the modified Rankin Scale>2 (mRS>2) was defined as poor prognosis and the scores of mRS≤2 was defined as excellent outcome. Stepwise Logistic regression models were used to analyze potential factors affecting the prognosis. The levels of serum uric acid in the patients with excellent outcome were significantly higher than in patients with poor outcome [(375±42) µmol/L vs (250±36) µmol/L, P=0.0026]. Logistic regression analysis revealed that high level of serum uric acid was related to excellent outcome (OR=1.25, 95% CI, 1.04-1.47, P=0.013). The serum uric acid level of non HT patients was significantly higher than the HT patients [(350±51) µmol/L vs (282±38) µmol/L, P=0.015]. After adjustment for the influence factors including age and hypertension, the level of uric acid was still negatively correlated with HT. Increased serum uric acid levels are associated with low incidence of HT and better prognosis in patients with stroke treated with reperfusion therapy.