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

Hutchison, Richard L.; Miller, Hannah M.; Michalke, Spencer K

doi:10.1177/1558944718800731

Cited by 22 publications

(9 citation statements)

References 36 publications

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“…We have read with interest the recently published article “The use of tPA in the Treatment of Frostbite: A systematic Review” by Dr. Richard Hutchison et al published in the January 2019 issue. 1 We applaud them for their efforts to study this difficult problem and agree with much of their findings. However, we believe their final recommendation to avoid the use of thrombolytics in frostbite patients unless conducting in an active research protocol may be misleading to readers.…”

supporting

confidence: 68%

Comments on “The Use of tPA in the Treatment of Frostbite: A Systematic Review”

Drinane

Kotamarti

Ricci

2019

Hand (New York, N,Y.)

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We have read with interest the recently published article "The use of tPA in the Treatment of Frostbite: A systematic Review" by Dr. Richard Hutchison et al published in the January 2019 issue. 1 We applaud them for their efforts to study this difficult problem and agree with much of their findings. However, we believe their final recommendation to avoid the use of thrombolytics in frostbite patients unless conducting in an active research protocol may be misleading to readers. We have found thrombolysis to be an effective means of limb salvage for severe frostbite at our institution, which is a tertiary referral center evaluating numerous frostbite victims annually. (Figure 1) We believe their findings might dissuade others from attempting thrombolytic ther-850629H ANXXX10.

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supporting

confidence: 68%

Comments on “The Use of tPA in the Treatment of Frostbite: A Systematic Review”

Drinane

Kotamarti

Ricci

2019

Hand (New York, N,Y.)

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“…The average level of evidence included is also low, at Level III. The included studies had an average MINORS score of 12.5 (range: [6][7][8][9][10][11][12][13][14][15][16][17][18][19][20][21][22] which is expected as this review included case reports, case series, and retrospective studies. Another important limitation of our work is that we cannot determine if thrombolysis preserved length of the amputated structures, thereby reducing the functional limitations of the amputations, or if it salvaged the soft tissue reducing the need for soft tissue reconstruction.…”

Section: Discussionmentioning

confidence: 99%

“…Although prior systematic reviews have been conducted on this topic previously, the focus of these prior reviews was to determine efficacy of thrombolysis, proper patient selection, and safety. [8][9][10][11] The findings of these prior reviews were clear: for patients presenting within 24 hours of injury, with failure of rapid rewarming, radiographic signs of a vascular defect and able to tolerate thrombolysis would benefit from thrombolysis. [8][9][10] However, none of these prior reviews have determined if the site of injury affects the treatment success.…”

Section: Introductionmentioning

confidence: 99%

Thrombolytic Salvage of the Frostbitten Upper Extremity: A Systematic Review

Drinane

Heiman

Ricci

et al. 2020

Hand (New York, N,Y.)

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Background Vascular thrombosis secondary to frostbite can lead to ischemic tissue damage in severe cases. Threatened extremities may be salvaged with thrombolytics to restore perfusion; however, current data are limited to single institution case series. The authors performed a systematic review to determine the efficacy of thrombolytic therapy in treating upper extremity frostbite. Methods PubMed, EBSCO, and Google Scholar were queried using the keywords “thrombolytics,” “frostbite,” “fibrinolytics,” and “tPA.” Exclusion criteria were failure to delineate anatomic parts injured, failure to report number of limbs salvaged, animal studies, and non-English language publications. Thrombolytic therapy was defined as intraarterial (IA) or intravenous (IV) administration of tissue plasminogen activator (tPA), alteplase, urokinase, streptokinase, or any tPA derivative. Results A total of 42 studies were identified, with 13 satisfying inclusion criteria. Eight studies reported catheter-directed IA thrombolysis, four reported systemic IV administration, and 1 reported both methods. A total of 157 patients received thrombolytics. In all, 73 upper extremity digits were treated by IA route and 136 digits were treated by IV route. Overall upper extremity digit salvage rate was 59%. There was a significantly higher salvage rate in digits treated by the IA route compared to the IV route. Conclusions Thrombolytics, particularly when administered by the intra-arterial route, are emerging as a promising treatment of severe frostbite of the upper extremity, increasing digit salvage rates.

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“…Nonetheless, the tPA application route seems puzzling, the intra-arterial or intravenous delivery methods may result in various complications, and there is no statement to clarify the choice of application route. 14 More robust evidence and clear instructions are required in the future application of tPA. As for the time of thrombolytic intervention, it is recognized that thrombolytic therapy should be given as soon as possible after rewarming.…”

Section: Discussionmentioning

confidence: 99%

Management and Outcome of Feet Deep Frostbite Injury (III and IV Degrees): A Series Report of 36 Cases

Zhang

Zhao

et al. 2020

The International Journal of Lower Extremity Wounds

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Deep feet frostbite is a severe trauma and often leads to amputation due to full-thickness skin necrosis and subcutaneous tissue damage. A retrospective analysis was performed between June 2013 and June 2019 to review the management measures and outcomes of clinical treatment, and available data had been collected including demographic characteristics, risk factors, and injury environment record. Treatment protocols, wound management, and outcomes were also presented. There were 36 patients diagnosed with deep feet frostbite with a mean age of 51.5 years; the ratio for male to female is 5:1. Drunk and mental disorders were the main risk behaviors for frostbite occurrence. As for the injury environment, mean temperature and wind speed were −20.5 °C and 3.3 m/s, respectively. Fourteen cases achieved wound healing without surgery intervention, 5 cases received skin graft, and 17 cases received amputation. Most amputations (12 cases) were restricted at toe level; only 1 case received whole feet amputation. Our finding indicated that feet deep frostbite in our hospital showed a male predominant and older age including various risk behaviors and coexistence risk factors. Clinical management based on pathology mechanism needs further improvement, as the amputation rate was still high. How to avoid amputation and lower the amputation level are the focus of future efforts.

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

Cited by 22 publications

References 36 publications

Comments on “The Use of tPA in the Treatment of Frostbite: A Systematic Review”

Comments on “The Use of tPA in the Treatment of Frostbite: A Systematic Review”

Thrombolytic Salvage of the Frostbitten Upper Extremity: A Systematic Review

Management and Outcome of Feet Deep Frostbite Injury (III and IV Degrees): A Series Report of 36 Cases

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