The use of intravenous tPA for the treatment of severe frostbite.
OBJECTIVE
tPA and anticoagulation for treatment of severe frostbite have been reported suggesting differences in imaging techniques, route of tPA administration and management of patients after tPA infusion. This is a report of our results following a protocol of Tc-99m scanning, intravenous tPA administration, followed by either systemic anticoagulation or antiplatelet therapy.


METHODS
Patients admitted to our burn center between February 13, 2015 and February 13, 2016 for frostbite who met inclusion criteria were treated with Tc-99m scan and intravenous tPA followed by systemic anticoagulation or antiplatelet therapy. Inclusion criteria included rewarming had not started more than 24h prior to the scan and no contraindications to the use of tPA.


RESULTS
Fifteen patients met inclusion criteria and 12 were treated according to the protocol. Nine received scans with 2 showing normal perfusion. Seven displayed perfusion defects and received intravenous tPA. Five recovered fully after tPA. Two who showed improved but abnormal scans after tPA experienced bleeding complications necessitating stopping heparin/Coumadin. Those two went on to partial amputation of digits.


CONCLUSIONS
The use of intra-arterial or intravenous tPA along with angiography or Tc-99m scanning followed by systemic anticoagulation or antiplatelet therapy may be beneficial to patients suffering frostbite.
Department of Surgery, Division of Critical Care, Trauma and Burn, The Ohio State University Wexner Medical Center, 410 West 10th Avenue, Columbus, OH 43210, USA. Electronic address: larry.jones@osumc.edu.
Larry M
LM
Jones
Department of Surgery, Division of Critical Care, Trauma and Burn, The Ohio State University Wexner Medical Center, 410 West 10th Avenue, Columbus, OH 43210, USA. Electronic address: Rebecca.coffey@oSumc.edu.
Rebecca A
RA
Coffey
Department of Radiology, Division of Nuclear Medicine, The Ohio State University Wexner Medical Center, 410 West 10th Avenue, Columbus, OH 43210, USA. Electronic address: mona.natwa@osumc.edu.
Mona P
MP
Natwa
Department of Surgery, Division of Critical Care, Trauma and Burn, The Ohio State University Wexner Medical Center, 410 West 10th Avenue, Columbus, OH 43210, USA. Electronic address: john.bailey@osumc.edu.
J Kevin
JK
Bailey
D061605:Administration, Intravenous; D000328:Adult; D000368:Aged; D000925:Anticoagulants / Q000627:therapeutic use; D005260:Female; D005343:Fibrinolytic Agents / Q000008:administration & dosage*; D005627:Frostbite / Q000188:drug therapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use; D015912:Thrombolytic Therapy / Q000379:methods*; D010959:Tissue Plasminogen Activator / Q000008:administration & dosage*; D014859:Warfarin / Q000627:therapeutic use; D055815:Young Adult
D000925:Anticoagulants; D005343:Fibrinolytic Agents; D010975:Platelet Aggregation Inhibitors; D014859:Warfarin; D010959:Tissue Plasminogen Activator
Anti-platelet therapy; Frostbite; Intravenous tPA