Time is Brain: A Scoping Review of Barriers to Timely Thrombolysis in Ischemic Stroke

Abstract

Introduction: Ischemic stroke is a medical emergency that requires treatment to be initiated within the first 4.5 hours, which is the therapeutic window for alteplase to minimize the onset of severe and irreversible sequelae. Although studies on its management exist, gaps remain in the systematic analysis of the factors that explain delays in treatment. Thus, this review stands out by comprehensively mapping the barriers that compromise timely thrombolysis. Objective: To verify, based on the literature, the factors associated with delays in thrombolytic therapy for ischemic stroke. Materials and Methods: This is a qualitative, exploratory study, of the scoping review type, conducted in the Web of Science, Scopus, MEDLINE, Embase, and PubMed databases in 2025. The search and screening were conducted by two reviewers in a double-blind process using Rayyan.ai software. The process followed the guidelines of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses: Extension for Scoping Reviews, resulting in the inclusion of 30 articles. Results: Obstacles were identified and categorized as socioeconomic conditions, geographic factors, lack of knowledge, cultural habits, health care logistics, variations in the disease’s presentation, and medical history; collectively, these factors constitute barriers that hinder timely treatment and contribute to the morbidity and mortality associated with the disease. Conclusion: The findings highlight the importance of integrated strategies for public health education, professional training, and strengthening the logistics and infrastructure of health services. Identifying and addressing these gaps helps promote public policies that reduce morbidity and mortality and improve the population’s quality of life.