Small blood clots that form during warming therapy can cause frostbite sufferers to lose digits. But in a small study, the clotbusting drug tPA greatly lowered the amputation rate. Steve Mirsky reports.
Frostbite treatment hasn’t changed much in the last 25 years. The basic therapy is to rewarm the frozen tissue, wait and hope you don’t have to amputate. Which you often do have to do. In fact, an axiom among doctors is “Frostbite in January, amputate in July.” But a small study just published in the Archives of Surgery suggests something new might be on the horizon for frostbite victims. Researchers theorized that a medication used to dissolve blood clots might be effective in frostbite. It’s called tissue plasminogen activator, or tPA.
One of the big problems in frostbite therapy is inflammation during thawing. The inflammation stimulates clotting that blocks small blood vessels, causing cell death. The tPA apparently keeps clots from forming, sparing the cells. In the study, six frostbite victims received tPA within 24 hours of suffering their freezing injuries, while 25 others got traditional treatment. That latter group, treated conventionally, lost 41 percent of their affected fingers and toes. But the tPA-treated patients wound up losing just 10 percent of their frostbitten digits. Future studies should help standardize the timing and duration of clotbusting drug administration.