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Bleeding Complications in Patients With Severe Frostbite Injury.

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Tissue plasminogen activator (tPA) is a safe and effective treatment for severe frostbite, preventing amputations with a low risk of bleeding complications. This study found no significant difference in severe bleeding between patients treated with or without tPA.

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Area of Science:

  • Emergency Medicine
  • Trauma Surgery
  • Vascular Surgery

Background:

  • Frostbite from cold exposure can cause severe tissue injury, potentially leading to amputations.
  • Tissue plasminogen activator (tPA), a thrombolytic agent, shows promise in preventing frostbite-related amputations.
  • Managing frostbite with tPA aims to salvage tissue while minimizing bleeding risks.

Purpose of the Study:

  • To characterize and compare bleeding complications in severe frostbite patients managed with and without tPA.
  • To evaluate the safety and efficacy of tPA in frostbite treatment.

Main Methods:

  • Retrospective chart review of severe frostbite patients at a verified burn center over 7 years.
  • Categorization of bleeding events into four groups (0-3) based on severity and intervention.
  • Comparison of bleeding complication rates between tPA-treated and non-tPA-treated groups.

Main Results:

  • 188 patients were included; most had no significant bleeding (69.7% category 0, 19.1% category 1).
  • No significant difference in severe bleeding (category 2 or 3) was observed between tPA and non-tPA groups.
  • 6.3% of tPA-treated patients experienced category 2 or 3 bleeding within 12 hours, and 8.4% within 24 hours.

Conclusions:

  • tPA demonstrates a low risk of severe bleeding complications in frostbite management.
  • The benefits of tPA for limb and digit salvage outweigh the bleeding risks in selected patients.
  • tPA is considered safe and effective for treating severe frostbite.