The Use of Thrombolytic Therapy in the Treatment of Frostbite Injury

Wexler, Allyson; Zavala, Sarah

doi:10.1097/bcr.0000000000000512

Cited by 21 publications

(7 citation statements)

References 10 publications

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“…The 8 case series reported on 128 patients. 17,[27][28][29][30][31][32][33] Three studies were case reports. [34][35][36] A total of 208 patients were included in the treatment groups.…”

Section: Resultsmentioning

confidence: 99%

The Use of tPA in the Treatment of Frostbite: A Systematic Review

Hutchison

Miller

Michalke

2018

Hand (New York, N,Y.)

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“…The 8 case series reported on 128 patients. 17,[27][28][29][30][31][32][33] Three studies were case reports. [34][35][36] A total of 208 patients were included in the treatment groups.…”

Section: Resultsmentioning

confidence: 99%

The Use of tPA in the Treatment of Frostbite: A Systematic Review

Hutchison

Miller

Michalke

2018

Hand (New York, N,Y.)

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“…Four patients required amputation. All 29 digits amputated had grade 4 frostbite; the majority of digits amputated (19) were from 1 patient.…”

Section: Discussionmentioning

confidence: 98%

Management of severe frostbite with iloprost, alteplase and heparin: a Yukon case series

Poole

Gauthier

MacLennan

2021

cmajo

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F rostbite can occur in cold climates, affecting a range of patients from those who are homeless or unwell, to athletes in extreme sports events. The impact of severe frostbite can be debilitating. Frostbite injuries are a result of an initial extracellular freezing injury followed by a reperfusion injury due to vasoconstriction and microthrombosis in affected tissues. 1 The severity of injuries can range from mild to severe. A grading system developed by Cauchy and colleagues 2,3 describes grade 1 to grade 4 frostbite. The higher the grade, the more proximal the cyanotic changes in the digits, and the higher the amputation rate.The foundations of frostbite treatment have included rapid rewarming 4 and antithromboxane agents such as aloe vera for topical use and ibuprofen. 5 More recently, vasodilators and thrombolytics have been promoted to address the reperfusion injury caused by vasoconstriction and thrombosis. Beginning in the 1990s, a growing body of evidence has popularized the use of iloprost in frostbite, first in Europe and now in Canada. 6,11,15,16,21,24,27 Iloprost, a synthetic prostacyclin analogue, is a potent vasodilator that inhibits platelet aggregation and enhances fibrinolytic activity by releasing endogenous tissue plasminogen activator. 29 To our knowledge, there is a single randomized controlled trial published to date showing the benefit of iloprost combined to alteplase and heparin. 11 We developed and implemented a frostbite treatment protocol and preprinted orders at our institution based on the best available evidence in February 2015. The aim of the present study was to describe the demographic characteristics, treatment course and clinical outcomes of patients treated as per our protocol.

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“…Thermal burns due to extreme cold were the subject of several articles, including the use of thrombolysis and a new scoring system, including an evaluation of the socioeconomic and cost and challenges of care provision for frostbite patients., 69,[241][242][243][244][245]…”

Section: Frostbitementioning

confidence: 99%

Acute Management of Thermal Hand Burns in Adults

et al. 2021

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Introduction Advances in the evidence base of acute thermal hand burns help to guide the management of these common injuries. The aim of this literature review was to evaluate recent evidence in the field over 10 years. Methods The Preferred Reporting Items for Systematic Reviews and Meta-Analysis Protocols methodology was used as a guide for this literature review. PubMed, MEDLINE, EMBASE, CINAHL, and Google Scholar were searched for English language articles related to hand burns published between 2009 and 2018 inclusive, and the Cochrane Library was reviewed. Exclusion criteria were as follows: participants younger than 18 years, scar or contracture management, rehabilitation, outcomes assessment, late reconstruction, and electrical or chemical burns. Results An initial search retrieved 6493 articles, which was narrowed to 403 full-text articles that were reviewed independently by 3 of the authors and categorized. Of 202 included articles, there were 8 randomized controlled trials and 2 systematic reviews. Six evidence-based guidelines were reviewed. Referral of hand burns to specialist centers, use of telemedicine, early excision and grafting, and immediate static splintage have been recommended. Enzymatic debridement results in earlier intervention, more accurate burn assessment, preservation of vital tissue, and fewer skin grafts, and ideally requires regional anesthesia. Guidance on escharotomy emphasizes indication, technique and adequate intervention, and potential for enzymatic debridement. Inclusion of topical negative pressure, dermal regenerative templates, acellular dermal matrices, and noncellular skin substitutes in management has helped improve scar and functional outcomes. Discussion The results of this literature review demonstrate that multiple national and international societies have published burns guidelines during the decade studied, with aspects directly relevant to hand burns, including the International Society for Burn Injuries guidelines. There are opportunities for evidence-based quality improvement across the field of hand burns in many centers. Conclusions More than 200 articles globally in 10 years outline advances in the understanding of acute management of thermal hand burns. Incorporating the evidence base into practice may facilitate optimization of triage referral pathways and acute management for hand burns.

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The Use of Thrombolytic Therapy in the Treatment of Frostbite Injury

Cited by 21 publications

References 10 publications

The Use of tPA in the Treatment of Frostbite: A Systematic Review

The Use of tPA in the Treatment of Frostbite: A Systematic Review

Management of severe frostbite with iloprost, alteplase and heparin: a Yukon case series

Acute Management of Thermal Hand Burns in Adults

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