A preliminary study suggests that a blood clot-dissolving medication that is administered to some patients following a stroke or heart attack may help to reduce the risk of amputation following severe frostbite, according to a report in the June issue of Archives of Surgery, one of the JAMA/Archives journals.
Frostbite treatment has remained essentially the same for the past 25 years, according to background information in the article. “Today, traditional therapy consists of tissue rewarming, prolonged watchful waiting and often delayed amputation,” the authors write. “While many other areas of burns, trauma and critical care have advanced significantly in their treatment modalities, the saying ‘Frostbite in January, amputate in July’ is still relevant today.”
Kevin J. Bruen, M.D., and colleagues at the University of Utah, Salt Lake City, studied the anti-clotting agent tissue plasminogen activator (tPA) for the treatment of frostbite beginning in 2001. Patients who were admitted with severe frostbite underwent imaging studies to assess blood flow to the affected limb. From 2001 to 2006, six patients with abnormal blood flow on angiography received tPA within 24 hours of severe frostbite injury. These individuals were compared with 25 frostbite patients treated from 1995 to 2006 who did not receive tPA, plus one who received tPA more than 24 hours after injury.
Among the six patients who received tPA within 24 hours of injury, six of 59 (10 percent) affected fingers or toes were amputated, compared with 97 of 234 (41 percent) among those who did not receive tPA. “Moreover, no proximal [closer to the body than the fingers or toes] amputations were required in the patients who received tPA within 24 hours in our series,” the authors write. “The control group underwent 14 proximal amputations, including five below the knee. The preservation of limbs, which maximizes patient functional outcome, is perhaps the greatest benefit conferred by u
Source:JAMA and Archives Journals