Efficacy of intravenous tissue plasminogen activator in frostbite patients and presentation of a treatment protocol for frostbite patients

Foot Ankle Spec. 2011 Dec;4(6):344-8. doi: 10.1177/1938640011422596. Epub 2011 Sep 30.


Frostbite can be a devastating and even debilitating injury. Early identification and proper treatment of frostbite is critical in saving digits and limbs. Tissue plasminogen activator (tPA) has been shown to be effective in reducing the number of digits amputated after severe frostbite injury. Nothing has been presented in the podiatric literature regarding the use of tPA in treating frostbite patients for preserving toes and feet. Intravenous tPA and IV heparin were used to treat severe frostbite injuries that did not show improvement after rapid rewarming, had absent Doppler pulses in the distal limb or digits, showed limited or no perfusion by Tc-99 3-phase bone scan, and had no contraindications to use of tPA. All 11 patients included in this study were treated at Hennepin County Medical Center between 2008 and 2010. A total of 73 digits (upper and lower extremity) were considered at risk for amputation after evaluation with Tc-99 bone scan. Of those digits that were affected, 43 were amputated. Intravenous tPA is a safe and effective treatment to reduce the number of digital amputations after severe frostbite injury. The authors' protocol for treating severe frostbite includes the use of tPA.

Levels of evidence: Therapeutic, Level IV.

MeSH terms

  • Adult
  • Amputation, Surgical
  • Fibrinolytic Agents / therapeutic use*
  • Finger Injuries / therapy*
  • Fingers / blood supply
  • Fingers / diagnostic imaging
  • Fingers / surgery
  • Frostbite / therapy*
  • Heparin / therapeutic use
  • Humans
  • Infusions, Intravenous
  • Middle Aged
  • Pulse
  • Radionuclide Imaging
  • Radiopharmaceuticals
  • Retrospective Studies
  • Severity of Illness Index
  • Technetium Tc 99m Sestamibi
  • Tissue Plasminogen Activator / therapeutic use*
  • Toes / blood supply
  • Toes / diagnostic imaging
  • Toes / injuries*
  • Toes / surgery
  • Young Adult


  • Fibrinolytic Agents
  • Radiopharmaceuticals
  • Heparin
  • Technetium Tc 99m Sestamibi
  • Tissue Plasminogen Activator