Objective: To assess the frequency, associated factors, and underlying vasculopathy of new remote cerebral microbleeds (CMB), as well as the risk of concomitant hemorrhagic complications related to new CMBs, after intravenous thrombolysis (IVT) in acute stroke patients. Methods: We conducted an observational study using data from our local thrombolysis registry. We included consecutive stroke patients with MRI (3-Tesla)-based IVT and a follow-up MRI the next day between 2008–2017 (n=396). Only CMBs located outside of the ischemic lesion(s) were considered. We also performed a meta-analysis on new CMBs after IVT that included two additional studies. Results: In our cohort, new remote CMBs occurred in 16/396 patients (4.0%) after IVT and the distribution was strictly lobar in 13/16 patients (81%). Patients with pre-existing CMBs with a strictly lobar distribution were significantly more likely to have new CMBs after IVT (p=0.014). In the random-effects meta-analysis (n=741), the pooled cumulative frequency of new CMBs after IVT was 4.4%. A higher pre-existing CMB burden (>2) was associated with a higher likelihood of new CMBs (odds ratio [OR] 3.6, 95% confidence interval [CI] 1.3–10.3) and new CMBs were associated with the occurrence of remote parenchymal hemorrhage (OR 28.8, 95%CI 8.6–96.4). Conclusions: New remote CMBs after IVT occurred in 4% of stroke patients, mainly had a strictly lobar distribution, and were associated with IVT-related hemorrhagic complications. Pre-existing CMBs with a strictly lobar distribution and a higher CMB burden were associated with new CMBs after IVT, which may indicate an underlying cerebral amyloid angiopathy.