Stroke Drug Saves Limbs After Frostbite

(Ivanhoe Newswire) -- New research shows a clot-busting drug commonly used in stroke patients can also save limbs from amputation after severe frostbite.

Researchers from the University of Utah studied the clot-dissolving agent tissue plasminogen activator (tPA) in six patients who were admitted to the hospital with severe frostbite. Those patients received tPA within 24 hours of getting severe frostbite and were compared to 25 patients previously admitted to the hospital who did not receive the treatment as well as one patient who received the tPA treatment more than 24 hours after the frostbite injury.

Results of the study show, collectively, just 10 percent of the fingers and toes of patients who received tPA were amputated, while 41 percent of the previous patients' fingers and toes were amputated. In the six treated patients, none required any other amputation besides a finger or toe. In the previous 26 patients, there were 14 amputations beyond fingers and toes, including five below the knee. Authors of the study write, "The preservation of limbs, which maximizes patient functional outcome, is perhaps the greatest benefit conferred by use of tPA in frostbite injury."

Researchers believe tPA reduces injury after frostbite due to its effect on the body as the skin thaws. Inflammation during thawing can cause clots that block the small blood vessels, which in turn causes cell death. Researchers say tPA reverses this clotting, so blood flow is restored before any permanent damage is done.

Authors of the study say more studies are needed to confirm the findings but they write, "Based on the dramatic improvements in [blood flow] and reduction in rates of amputations when tPA was administered within 24 hours of frostbite injury, we anticipate the continued use of tPA in patients who are admitted to our institution with acute frostbite."

Researchers add that the treatment of frostbite has remained virtually unchanged for the last 25 years. They write, "Classic management of frostbite injury includes resuscitation, rewarming and watchful waiting. The outcome is either tissue recovery or progressive gangrene leading to eventual amputation."

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SOURCE: Archives of Surgery, 2007;142:546-553