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Reducing Amputation Rates After Severe Frostbite


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Am Fam Physician. 2015 Oct 15;92(8):716.

Clinical Question

Is tissue plasminogen activator (tPA) effective in reducing digital amputation rates in patients with severe frostbite?

Evidence-Based Answer

In patients with severe frostbite, tPA plus a prostacyclin may be used to decrease the risk of digital amputation. (Strength of Recommendation [SOR]: B, based on a single randomized controlled trial [RCT].) tPA can be used alone and is associated with lower amputation rates compared with local wound care. (SOR: C, based on lower-quality cohort studies.)

A 2011, open-label RCT (n = 47) compared tPA plus iloprost (Ventavis), iloprost alone, and buflomedil (not available in the United States) in patients with frostbite extending just past the proximal phalanx or injury proximal to the metacarpal or metatarsal joint.1 Digital perfusion was not assessed before treatment. All patients

Address correspondence to Jennifer Taves, MD, at jennifer.taves@centracare.com. Reprints are not available from the authors.

Author disclosure: No relevant financial affiliations.


1. Cauchy E, et al. A controlled trial of a prostacyclin and rt-PA in the treatment of severe frostbite. N Engl J Med. 2011;364(2):189–190.

2. Bruen KJ, et al. Reduction of the incidence of amputation in frostbite injury with thrombolytic therapy. Arch Surg. 2007;142(6):546–551.

3. Twomey JA, et al. An open-label study to evaluate the safety and efficacy of tissue plasminogen activator in treatment of severe frostbite. J Trauma. 2005;59(6):1350–1354.

Help Desk Answers provides answers to questions submitted by practicing family physicians to the Family Physicians Inquiries Network (FPIN). Members of the network select questions based on their relevance to family medicine. Answers are drawn from an approved set of evidence-based resources and undergo peer review.

The complete database of evidence-based questions and answers is copyrighted by FPIN. If interested in submitting questions or writing answers for this series, go to http://www.fpin.org or email: questions@fpin.org.

This series is coordinated by John E. Delzell, Jr., MD, MSPH, Assistant Medical Editor.

Copyright Family Physicians Inquiries Network. Used with permission.


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