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Empiric tPA: an Effective Therapy for Frostbite of the Hand
Michael Subichin MD, Benjamin Lou MD
Summa Health System
2018-02-14
Presenter: Michael Subichin MD
Affidavit:
The resident was responsible for the vast majority of conception, acquisition of data, analysis, and drafting of the abstract
Director Name: Douglas Wagner MD
Author Category: Resident Plastic Surgery
Presentation Category: Clinical
Abstract Category: Hand
Introduction
Severe frostbite of the upper extremity is a devastating disease process. Historically, this has been managed expectantly with a digit amputation rate of 50%. Over the last 10 years, strategies have emerged to improve frostbite care including the use of thrombolytic therapy. Unfortunately, these protocols are delayed by the use of angiography and nuclear medicine bone scans. We sought to determine the utility of empiric thrombolytic therapy for severe frostbite of the upper extremity.
Patients and Methods
We reviewed patients who presented with frostbite of the upper extremity to the Burn Institute at Akron Children's Hospital. Six patients were identified who received empiric thrombolytic therapy immediately after rewarming. Regimen includes intravenous tPA bolus and infusion, followed by 2 weeks of therapeutic enoxaparin. All patients were evaluated at outpatient follow up for need for amputation. We collected digit involvement, patient demographics, complications from tPA, and the need for digit amputation. ANOVA and fisher's exact test were used for all analysis.
Results
All 6 patients successfully completed the thrombolytic protocol. A total of 60 digits were involved with severe frostbite (grade III or IV frostbite). Of the 60 digits involved, 46 digits were salvaged. In comparison to an historic control, tPA lead to significantly higher digit salvage rate (50% vs 77% p<0.01).
Conclusion
Our experience shows that there is a high success rate of digit salvage when empiric tPA is used. If eligible, we recommend the use of tPA at presentation without the use of pretreatment nuclear medicine imaging or angiography.
