An open-label study to evaluate the safety and efficacy of tissue plasminogen activator in treatment of severe frostbite
ABSTRACT Severe frostbite can have devastating consequences with loss of limbs and digits. One of the mechanisms of cold injury to human tissue is vascular thrombosis. The effect of tissue plasminogen activator (tPA) and heparin in limb and digit preservation in severe frostbite patients has not been previously studied.
Intra-arterial (6 patients) or intravenous (i.v., 13 patients) tPA and IV heparin were used in patients with severe frostbite. All patients between January 1, 1989 and February 1, 2003 with severe frostbite not improved by rapid rewarming, with absent Doppler pulses in distal limb or digits, without perfusion by Technetium (Tc) 99m three-phase bone scan, and no contraindication to tPA use were eligible. Efficacy was assessed on the basis of predicted digit amputation before therapy, given the clinical and Tc-99m scan results, versus partial or complete digits removed.
There were no complications with i.v. tPA. Two patients with intra-arterial TPA had bleeding complications. We know from historical Tc-99m scan data which digits were at risk for amputation. In this study, there were 174 digits at risk in 18 patients and only 33 were amputated.
Intravenous tPA and heparin after rapid rewarming is safe and reduced predicted digit amputations considerably. Patients with no response to thrombolytic therapy were those with more than 24 hours of cold exposure, warm ischemia times greater than 6 hours, or evidence of multiple freeze-thaw cycles. Our algorithm for treatment of severe frostbite now includes use of i.v. tPA for patients without contraindications.
Article: Frostbite.Journal of WOCN 35(3):341-6; discussion 347-9. DOI:10.1097/01.WON.0000319135.19176.d8 · 1.00 Impact Factor
Article: Drei Fallberichte über Erfrierungen[Show abstract] [Hide abstract]
ABSTRACT: Die Anzahl von Erfrierungen nimmt auf Grund sozialer sowie demographischer Veränderungen und eines gewandelten Freizeitverhaltens zu. Die Auswirkungen für die Betroffenen sind auf Grund der Lokalisation insbesondere an Händen und Füßen immens. Wir stellen Hilfen zur Einteilung und aktuelle Therapieregime bei Erfrierungen vor. Veranschaulicht werden diese an Hand dreier Patienten mit unterschiedlichen Risikoprofilen, die in unserer Klinik mit Erfrierungen vorstellig wurden. Due to social and demographic changes as well as new leisure activities, the number of frostbite injuries in the general population is on the increase. Because the injuries are primarily located on the hands and feet the consequences for those concerned are devastating. We provide help in grading and introduce concrete therapeutic regimes for frostbite which are illustrated by three case reports from our clinical experience with varying risk profiles. SchlüsselworteErfrierung–Behandlungskonzepte–Einschätzung–Einteilung KeywordsFrostbite–Treatment options–Assessment–GradingDer Unfallchirurg 01/2011; 114(7):634-638. DOI:10.1007/s00113-010-1866-9 · 0.61 Impact Factor