What is the role of pharmacologic therapy in the treatment of frostbite?

Updated: Jul 29, 2019
  • Author: Bobak Zonnoor , MD; Chief Editor: Dirk M Elston, MD  more...
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Answer

Analgesics (eg, ibuprofen and morphine) for pain relief are indicated during and after rewarming.

Apply topical aloe vera cream to all frostbitten areas every 6 hours to inhibit the arachidonic cascade, especially thromboxane synthesis.

Administer tetanus prophylaxis (tetanus toxoid or immune globulin).

Antibacterial prophylaxis is generally not recommended. Frostbite infections tend to involve staphylococci, streptococci, enterococci, and Pseudomonas pathogens. If infection develops, oral or parenteral antibiotics should be administered based on local sensitivities.

While supporting evidence is limited, infusion of low-molecular-weight dextran may be beneficial by preventing erythrocyte clumping in cold-injured blood vessels, with an associated decrease in tissue necrosis. [43]

Growing evidence supports the use of intravenous or intra-arterial thrombolysis with tissue plasminogen activator (tPA) in the management of frostbite. When administered within 24 hours of thawing, it has been shown to decrease amputation rates. It is generally administered as a bolus followed by an infusion, along with heparin or enoxaparin. [44, 45] Thrombolysis should only be performed after a careful risk-benefit analysis and in a setting in which the patient can be closely monitored for complications. Thus, the current recommendation is intra-arterial tPA plus intravenous heparin in patients with high-risk amputations (eg, multiple digits, proximal amputation) without contraindications who present within 24 hours of injury. Some protocols include the addition of the vasodilator iloprost, a prostacyclin analog, which has been shown to reduce amputation rates. [16, 46, 47, 48, 49]


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