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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