Clot-busting drug helps with frostbite

By Staff
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CHICAGO, June 19 (Reuters) People with frostbite who were treated with a clot-busting drug typically used in stroke patients had fewer amputations than those who were not, suggesting another role for the drug, US researchers said.

Patients with frostbite often experience swelling as the frozen skin thaws, blocking tiny blood vessels.

Researchers said the addition of the anti-clotting drug tissue plasminogen activator, or tPA, helped keep blood flowing to the injured area, averting permanent damage.

''People had fewer amputations and less digit and limb loss as a result of their injury,'' said Dr. Amalia Cochran of the University of Utah in Salt Lake City, whose work appears in the Journal of the American Medical Association's Archives of Surgery.

Little has changed in the management of frostbite in the past 25 years, with routine treatment typically consisting of warming the patient, offering fluids, caring for wounds, and often months later, amputation.

The saying ''Frostbite in January, amputate in July'' still applies, the authors wrote.

A number of individual medical centers have tried the use of the clot buster tPA on an isolated basis, Cochran said, but there have been few studies of its use.

In this study, researchers examined six severe frostbite patients between 2001 and 2006 who were able to seek treatment within 24 hours of sustaining frostbite and did not have other injuries that would prohibit the use of the clot-busting drug.

''Getting them here within 24 hours was clearly a point of demarcation. That 24-hour cutoff seems to be important,'' Cochran said.

No patients who got the drug had a limb amputated, compared with 14 amputations among a comparison group of 26 who got standard care.

And only 10 per cent of affected fingers and toes were amputated in the drug group versus 41 per cent among those who did not get the drug.

''The preservation of limbs, which maximises patient functional outcome, is perhaps the greatest benefit conferred by the use of tPA in frostbite injury,'' Dr Kevin Bruen of the University of Utah, who led the study, said in a statement.

The drug cannot be used on all frostbite victims as many of them come to the hospital with other injuries involving internal bleeding, which would be worsened by the drug.

''Bleeding is clearly the biggest concern. That makes use a bit limited,'' Cochran said.

She said more studies at different centers are needed to confirm the findings and to determine if the drug would work differently in patients exposed to extreme cold all at once -- allowing for no intermittent periods of thawing -- compared with those whose injuries were the result of repeated freezing and thawing in less extreme temperatures.

''We don't know if their response would be better, worse of the same,'' she said.

REUTERS RJ RK0912

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