Analysis of barriers to the use of thrombolytics in ischemic stroke in a private hospital in Rio de Janeiro, Brazil

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.