Thrombolytic Therapy in Frostbite Injury
Thrombolytic Therapy in Frostbite Injury
June 19, 2007 — Thrombolytic therapy might reduce the need for amputation in frostbite injury, according to the results of a study reported in the June issue of the Archives of Surgery.
"The treatment of frostbite has remained essentially unchanged for the last 25 years," write Kevin J. Bruen, MD, from the University of Utah, in Salt Lake City, and colleagues. "Beginning in 2001, we employed thrombolytic therapy for severe cases of frostbite at our regional burn referral center. We hypothesized that our experience would demonstrate that thrombolytic therapy decreases the incidence of amputation when administered within 24 hours of exposure."
This retrospective review of clinical outcomes and resource use considered patients admitted to the burn unit of a tertiary academic referral center. From 2001 to 2006, patients who were admitted within 48 hours of severe frostbite injury underwent digital angiography and treatment with intra-arterial tissue plasminogen activator (tPA) if there was abnormal perfusion. These patients were compared with those treated from 1995 to 2006, who did not receive tPA.
Primary end points included number and type of surgery, amputations of digits (fingers or toes), and more proximal amputations (ray, transmetatarsal, or below-knee). The investigators also analyzed resource use, including length of hospital stay, total costs, cost per involved digit, and cost per saved digit.
Of 32 patients with digital involvement (hands, 19%; feet, 62%; both, 19%), 7 received tPA, 6 of whom received it within 24 hours of injury. Digital amputation occurred in 41% of patients who did not receive tPA. Of those who received tPA within 24 hours of injury, only 10% underwent amputation ( P < .05).
"Tissue plasminogen activator improved tissue perfusion and reduced amputations when administered within 24 hours of injury," the authors write. "This modality represents the first clinically significant advancement in the treatment of frostbite in more than 25 years."
Limitations to this study include small sample size, retrospective review, inability to compare equal groups for severity, lack of historical control group with angiographic evidence of the absence of blood flow, lack of data on functional outcomes, and inability to disprove that patients who received tPA might have improved on their own without thrombolytic therapy.
"Based on the dramatic improvements in perfusion and reduction in rates of amputations when tPA was administered within 24 hours of frostbite injury, we anticipate the continued use of tPA in patients who are admitted to our institution with acute frostbite," the authors conclude. "Additional studies are warranted to confirm our findings and to determine the best methods of assessing tissue damage and administering thrombolytics in terms of timing, duration, and route."
The Department of Surgery and the Burn Center at the University of Utah supported this study. The authors report no relevant financial relationships.
Arch Surg. 2007;142:546-553.
June 19, 2007 — Thrombolytic therapy might reduce the need for amputation in frostbite injury, according to the results of a study reported in the June issue of the Archives of Surgery.
"The treatment of frostbite has remained essentially unchanged for the last 25 years," write Kevin J. Bruen, MD, from the University of Utah, in Salt Lake City, and colleagues. "Beginning in 2001, we employed thrombolytic therapy for severe cases of frostbite at our regional burn referral center. We hypothesized that our experience would demonstrate that thrombolytic therapy decreases the incidence of amputation when administered within 24 hours of exposure."
This retrospective review of clinical outcomes and resource use considered patients admitted to the burn unit of a tertiary academic referral center. From 2001 to 2006, patients who were admitted within 48 hours of severe frostbite injury underwent digital angiography and treatment with intra-arterial tissue plasminogen activator (tPA) if there was abnormal perfusion. These patients were compared with those treated from 1995 to 2006, who did not receive tPA.
Primary end points included number and type of surgery, amputations of digits (fingers or toes), and more proximal amputations (ray, transmetatarsal, or below-knee). The investigators also analyzed resource use, including length of hospital stay, total costs, cost per involved digit, and cost per saved digit.
Of 32 patients with digital involvement (hands, 19%; feet, 62%; both, 19%), 7 received tPA, 6 of whom received it within 24 hours of injury. Digital amputation occurred in 41% of patients who did not receive tPA. Of those who received tPA within 24 hours of injury, only 10% underwent amputation ( P < .05).
"Tissue plasminogen activator improved tissue perfusion and reduced amputations when administered within 24 hours of injury," the authors write. "This modality represents the first clinically significant advancement in the treatment of frostbite in more than 25 years."
Limitations to this study include small sample size, retrospective review, inability to compare equal groups for severity, lack of historical control group with angiographic evidence of the absence of blood flow, lack of data on functional outcomes, and inability to disprove that patients who received tPA might have improved on their own without thrombolytic therapy.
"Based on the dramatic improvements in perfusion and reduction in rates of amputations when tPA was administered within 24 hours of frostbite injury, we anticipate the continued use of tPA in patients who are admitted to our institution with acute frostbite," the authors conclude. "Additional studies are warranted to confirm our findings and to determine the best methods of assessing tissue damage and administering thrombolytics in terms of timing, duration, and route."
The Department of Surgery and the Burn Center at the University of Utah supported this study. The authors report no relevant financial relationships.
Arch Surg. 2007;142:546-553.
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