Blood Clot Drug Helps Prevent Amputation After Frostbite – tPA Used To Reduce Risk In Frost Bite Victims

Blood Clot Drug Helps Prevent Amputation After Frostbite – tPA Used To Reduce Risk In Frost Bite Victims

Deep Frostbite

(Best Syndication) Utah researchers say that a common blood clot-dissolving drug used for stroke or heart attack may help to reduce the risk of amputation following severe frostbite. Right now the standard procedure is rewarming the tissue, but this new research may help save some patients from amputation.

Beginning in 2001 Kevin J. Bruen, M.D., and colleagues at the University of Utah, Salt Lake City, began administering the anti-clotting agent tissue plasminogen activator (tPA) to victims of severe frostbite. The patients underwent angiography imaging studies to assess blood flow to the affected limb.

Bruen compared six patients with abnormal blood flow who received tPA within 24 hours of severe frostbite injury with 25 frostbite patients treated from 1995 to 2006 who did not receive tPA. There was one other patient who received tPA more than 24 hours after injury. He continued to compare the drug.

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Ten percent (6 of 59) of those who received tPA had their affected fingers or toes amputated while 41 percent (97 of 234) of those who did not receive the drug had amputations. “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 use of tPA in frostbite injury.”

The researchers believe that tPA reduces the damage caused when frozen skin is warmed again. Also, inflammation during thawing normally stimulates clotting that blocks small blood vessels, leading to cell death. Because tPA reverses this clotting, blood flow is restored before permanent damage is done.

“Based on the dramatic improvements in perfusion [blood flow] 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 write. “Candidates for this therapy are patients who present with severe frostbite as suggested by full-thickness tissue involvement, hemorrhagic blisters and abnormal perfusion on either angiogram or pyrophosphate scanning. Initiation of therapy within 24 hours of rewarming also appears to be necessary. Exclusion criteria would include superficial frostbite, involvement of the tips of the distal phalanges and contraindications to tPA, including concurrent trauma, neurological impairment or recent surgery or hemorrhage.”

“Additional studies are warranted to confirm our findings and to determine the best methods of assessing tissue damage and administering thrombolytics [anti-clotting drugs] in terms of timing, duration and route,” they conclude. The research appears in the June issue of Archives of Surgery, one of the JAMA/Archives journals.

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By Marsha Quinn
Best Syndication News Health Writer



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