An open-label study to evaluate the safety and efficacy of tissue plasminogen activator in treatment of severe frostbite.

摘要: Background: Severe frostbite can have devastating consequences with loss of limbs and digits. One the mechanisms cold injury to human tissue is vascular thrombosis. The effect plasminogen activator (tPA) heparin in limb digit preservation severe patients has not been previously studied. Methods: Intra-arterial (6 patients) or intravenous (i.v., 13 tPA IV were used frostbite. All between January 1, 1989 February 2003 improved by rapid rewarming, absent Doppler pulses distal digits, without perfusion Technetium (Tc) 99m three-phase bone scan, no contraindication use eligible. Efficacy was assessed on basis predicted amputation before therapy, given clinical Tc-99m scan results, versus partial complete digits removed. Results: There complications i.v. tPA. Two intra-arterial TPA had bleeding complications. We know from historical data which at risk for amputation. In this study, there 174 18 only 33 amputated. Conclusion: Intravenous after rewarming safe reduced amputations considerably. Patients response thrombolytic therapy those more than 24 hours exposure, warm ischemia times greater 6 hours, evidence multiple freeze-thaw cycles. Our algorithm treatment now includes contraindications.