O acidente vascular cerebral isquêmico (AVCi) é uma importante causa de sequela e morte. A correta utilização do trombolítico enfrenta várias barreiras. O objetivo foi discutir as barreiras à terapia trombolítica em pacientes que chegam, com sintomas de AVCi agudo, à emergência de um hospital privado do Rio de Janeiro, Brasil. Coorte retrospectiva de pacientes entre 2009 e 2011. Foram admitidos 257 pacientes com suspeita de AVCi. Dos pacientes com diagnóstico confirmado (156), 11,5% (18) foram trombolisados. Dos 30 pacientes com diagnóstico de AVCi, dentro da janela terapêutica e com NIHSS na faixa para trombólise, 20 não foram trombolisados, 9 por barreiras administrativas (45%). Neste trabalho o percentual de trombólise foi superior ao observado nos Estados Unidos, mas barreiras impediram o tratamento de 45% dos pacientes com indicação à trombólise. Imagina-se que na rede pública brasileira a situação seja ainda mais desfavorável.

Ischemic stroke is a major cause of neurological sequelae and death. The correct use of thrombolytic therapy faces several barriers. The objective was to discuss barriers to thrombolytic therapy in a private hospital. This was a retrospective cohort study of patients with symptoms of acute ischemic stroke entering the emergency department of a private hospital in Rio de Janeiro, Brazil, from 2009 to 2011. 257 patients were admitted with suspected ischemic stroke. Among the 156 patients with confirmed diagnosis of ischemic stroke, 18 (11.5%) received thrombolytic therapy. Of the 30 patients with ischemic stroke within the therapeutic window and meeting NIHSS criteria for thrombolysis, 20 were not thrombolysed. Nine of these were due to administrative barriers (45%). In the current study, the thrombolysis rate was higher than in the United States, but barriers prevented treating 47.6% of patients with indication for thrombolysis. Importantly, this study was conducted in a private hospital, and the situation may be even more unfavorable in the public health system.