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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