Frostbite Resolution With Tissue Plasminogen Activator

Albert B. Lowenfels, MD


February 12, 2010

Case Records of the Massachusetts General Hospital. Case 41-2009. A 16-Year-Old Boy With Hypothermia and Frostbite.

Sheridan RL, Goldstein MA, Stoddard FJ Jr, Walker TG
N Engl J Med. 2009;361:2654-362

Case Summary

The authors of this case study report the saga of a intoxicated teenage patient who sustained severe frostbite of the upper and lower extremities but who had nearly full return of function after intra-arterial thrombolytic treatment. The patient, a 16-year-old boy, was found unconscious in a snow bank after consuming large quantities of alcohol. The blood alcohol level was 0.12%. Because both of his hands and his right foot were severely frostbitten, the patient received intra-arterial tissue plasminogen activator (tPA) to the upper extremities over a 24-hour period. Both the upper and lower extremities improved dramatically.


As in this patient, alcohol is often an underlying causative factor leading to frostbite. Current treatment involves rapid rewarming, usually in a water bath. In this patient, thrombolytic therapy was used because of radiographic evidence of diminished or absent arterial flow. Dramatic improvement occurred in all extremities, even though the tPA had been administered only to the arms. Just the great toe of one foot eventually required amputation. Using tPA therapy for suitably selected cases may reduce the need for amputation in patients with severe frostbite.



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