Thrombolytic Therapy May Reduce Amputation in Frostbite

A new study has found the thrombolytic therapy with tissue plasminogen activator (tPA) might reduce the need for amputation in frostbite injury.

Investigators from the University of Utah (Salt Lake City, USA) conducted a retrospective review of clinical outcomes and resource use considered for 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 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).

Of 32 patients with digital involvement (hands, 19%; feet, 62%; both, 19%), seven received tPA, six 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. The results of the study were published in the June 2007 issue of the Archives of Surgery.

"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,” concluded said lead author Kevin J. Bruen, M.D., and colleagues. "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.”

Limitations to the study include small sample size, retrospective review, inability to compare equal groups for severity, lack of historic 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.


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