Intra-arterial infusion of tissue plasminogen activator (tPA) can improve perfusion in frostbitten limbs in some patients. The patient should be carefully selected and the clinician adequately trained.
Patient selection - all of the following:
(1) frostbite of an extremity
(2) within 24 hours of the onset of the injury
(3) evidence of vascular compromise (decreased or absent pulses, ischemic discoloration of digits)
Relative contraindications:
(1) concurrent trauma
(2) recent surgery
(3) recent hemorrhage
(4) bleeding diathesis
(5) cold contact injury without frostbite
(6) evidence of freeze-thaw-freeze injury
(7) more than 24 hours since onset of frostbite injury
(8) unable to monitor or treat bleeding complications
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