IMPACTO DEL TIEMPO PUERTA-AGUJA EN LA EFICACIA DE LA TROMBÓLISIS CON ALTEPLASA EN EL ACCIDENTE VASCULAR CEREBRAL ISQUÉMICO: UNA REVISIÓN INTEGRATIVA
DOI:
https://doi.org/10.66104/k45s1f02Palabras clave:
Accidente Cerebrovascular Isquémico; Trombólisis intravenosa; Tiempo puerta-aguja; Alteplasa; Reperfusión cerebral.Resumen
Introducción: El Accidente Cerebrovascular Isquémico (ACVi) continúa siendo una de las principales causas de morbimortalidad y discapacidad funcional a nivel mundial, siendo la trombólisis intravenosa una de las principales estrategias terapéuticas para la restauración precoz de la perfusión cerebral. En este contexto, el tiempo puerta-aguja constituye un importante indicador pronóstico, ya que los retrasos terapéuticos están directamente asociados con la progresión de la lesión isquémica y peor evolución clínica. Objetivo: Analizar críticamente las evidencias científicas contemporáneas acerca del impacto del tiempo puerta-aguja sobre los desenlaces clínicos, funcionales y terapéuticos relacionados con la trombólisis intravenosa en el Accidente Cerebrovascular Isquémico. Metodología: Se trata de una revisión integradora de la literatura, realizada conforme las recomendaciones del PRISMA 2020. Las búsquedas fueron realizadas en las bases PubMed/MEDLINE, Scopus, Web of Science, Embase y SciELO, incluyendo estudios publicados entre 2020 y 2025 en portugués, inglés y español. Fueron incluidos ensayos clínicos, estudios observacionales, revisiones sistemáticas y estudios prospectivos relacionados con el tiempo puerta-aguja y la trombólisis intravenosa en el ACVi. La calidad metodológica fue evaluada mediante la Escala de Newcastle-Ottawa. Resultados: Fueron incluidos 17 estudios en la síntesis cualitativa final. Las evidencias demostraron asociación consistente entre reducción del tiempo puerta-aguja y mejora de los desenlaces neurológicos, incluyendo menor mortalidad hospitalaria, mayor independencia funcional y reducción de la discapacidad residual. Además, protocolos asistenciales estructurados, integración multiprofesional, neuroimagen avanzada y utilización de tecnologías digitales mostraron impacto positivo sobre la eficiencia terapéutica. La tenecteplasa presentó potencial operacional favorable en comparación con la alteplasa, aunque los resultados clínicos permanecieron heterogéneos entre diferentes poblaciones analizadas. Consideraciones finales: La reducción del tiempo puerta-aguja permanece como uno de los principales determinantes pronósticos relacionados con el manejo contemporáneo del ACVi. Estrategias dirigidas a la optimización de los flujos asistenciales, fortalecimiento de las redes de atención al ACV e incorporación de tecnologías terapéuticas y diagnósticas resultan fundamentales para mejorar los desenlaces clínicos relacionados con la reperfusión cerebral.
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Derechos de autor 2026 André Victor da Silva Jardim, Jordanna Rocha Cardoso Ferro, Leonardo da Paz de Queiroz Marques, Mikael José dos Santos Calmo, Weslley Anderson Barreto Ramos, Felipe Moraes Alecrim
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