ACIDENTE VASCULAR CEREBRAL ISQUÊMICO: ASPECTOS FISIOPATOLÓGICOS E O PAPEL DA ALTEPLASE NA TERAPIA TROMBOLÍTICA

Abstract

Ischemic stroke is one of the leading causes of mortality and neurological disability worldwide, resulting from the interruption of cerebral blood flow. This study aimed to review the pathophysiological mechanisms involved in ischemic stroke and analyze the role of alteplase in thrombolytic therapy, highlighting its clinical application and the pharmacist's role in the safe use of this medication. This is a narrative literature review, conducted in the PubMed, SciELO, Google Scholar, CAPES, Scopus, and Web of Science databases, complemented by official guidelines from health organizations, with a time frame from 2021 to 2026. Mechanisms such as energy failure, excitotoxicity, inflammation, ferroptosis, blood-brain barrier impairment, and cerebral edema were discussed, as well as the importance of neuroimaging in identifying the ischemic penumbra. The findings demonstrated that alteplase remains the gold standard in the treatment of acute ischemic stroke, promoting cerebral reperfusion through thrombus dissolution. However, its effectiveness depends on early administration, appropriate patient selection, and the integrated action of the multidisciplinary team, including the pharmacist, who is responsible for contributing to the safe and rational use of thrombolytic therapy. In conclusion, thrombolysis with alteplase represents an essential strategy in reducing neurological sequelae and improving clinical outcomes, provided it is performed within the therapeutic window and in properly structured healthcare facilities.