Thrombolytic Therapy Saves Frostbitten Limbs

Moreover, the catheter system for drug infusion is proximal above the elbow or knee rather than directly into the clot as is the current standard approach to arterial thrombolysis.

Despite its use at several U.S. centers for the last decade, thrombolysis for frostbite has not yet become the standard of care because there have been no published results until recently, and thus far those have mostly consisted of anecdotal reviews of outcomes with wide-ranging dosages and treatment variations.

“That is why in 2003 I decided to initiate [a Food and Drug Administration-approved] prospective trial with rigid guidelines for treatment. The hope was that more scientific results might encourage others to use this type of treatment. The problem is the disease tends to occur away from the major academic centers on the coasts,” he said.

Future considerations include possibly increasing the heparin dose to reduce rethrombosis (since no bleeding problems have been seen), adding antiplatelet drugs to reduce clot formation, and a possible randomized trial comparing intravenous and intra-arterial administration of the drugs. Two sites have reported some success with high-dose intravenous administration.

Fingers with deep frostbite (left) can be saved from amputation with restored blood flow (right) after treatment with tenecteplase, papaverine, and heparin. Photos courtesy Dr. George R. Edmonson