Table 3 A proposed screening and treatment tool for the use of thrombolysis in cases of frostbite [17]
From: Frostbite: a practical approach to hospital management
| Questions/indications to be considered | |
|---|---|
| Treatment screen (four ‘yes’ answers required to proceed to angiography) | Are the patient's gas exchange and haemodynamics stable? |
| Is flow absent after rewarming (no capillary refill or Doppler signals)? | |
| Was the cold exposure time less than 24 h? | |
| Is the warm ischaemia time less than 24 h? | |
| Treatment protocol | Perform angiography with intra-arterial vasodilators |
| If there is still no flow after angiography with vasodilators, infuse tissue plasminogen activator (rTPA) with systemic heparinization with priority to the hands; other sites receive a systemic dose | |
| Repeat angiography after 24 h | |
| Indications for stopping the infusion of the rTPA | When restored flow has been confirmed by angiography or clinical examination |
| If major bleeding complication occurs | |
| After 72-h treatment | |
| Post lysis anticoagulation | One month of subcutaneous low-molecular weight heparin at prophylactic dose |