Clotbusters for Frozen Toes
Bruen KJ, Ballard JR, Morris SE, Cochran A, Edelman LS, Saffle JR
Arch Surg. 2997;142:546-553
This retrospective study describes the benefit of thrombolytic therapy in the management of frostbite injury. During the period of 2001-2006, 32 patients were identified with frostbitten fingers or toes. Digital angiography was used for patients with evidence of circulatory compromise. Six patients received intra-arterial thrombolytic therapy with tissue plasminogen activator (tPA) within 24 hours of exposure. The other 26 patients were considered controls. Patients treated with tPA had a 10% incidence of amputations compared with 41% of patients not receiving tPA therapy (P ≤ .05).
The rationale for this therapeutic approach is that after rewarming the frozen extremity, local inflammation and coagulation lead to microvascular coagulation, which can be minimized by tPA. In this study, intra-arterial tPA therapy effectively minimized tissue loss in selected patients with frostbite. However, the results are based on a small number of patients and the information was obtained retrospectively. A larger randomized trial will be required to assess the value of this approach.
Abstract
Reduction of the Incidence of Amputation in Frostbite Injury With Thrombolytic Therapy
Bruen KJ, Ballard JR, Morris SE, Cochran A, Edelman LS, Saffle JR
Arch Surg. 2997;142:546-553
Summary
This retrospective study describes the benefit of thrombolytic therapy in the management of frostbite injury. During the period of 2001-2006, 32 patients were identified with frostbitten fingers or toes. Digital angiography was used for patients with evidence of circulatory compromise. Six patients received intra-arterial thrombolytic therapy with tissue plasminogen activator (tPA) within 24 hours of exposure. The other 26 patients were considered controls. Patients treated with tPA had a 10% incidence of amputations compared with 41% of patients not receiving tPA therapy (P ≤ .05).
Viewpoint
The rationale for this therapeutic approach is that after rewarming the frozen extremity, local inflammation and coagulation lead to microvascular coagulation, which can be minimized by tPA. In this study, intra-arterial tPA therapy effectively minimized tissue loss in selected patients with frostbite. However, the results are based on a small number of patients and the information was obtained retrospectively. A larger randomized trial will be required to assess the value of this approach.
Abstract
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