Medicine for the Outdoors
Medicine for the Outdoors

Dr. Paul Auerbach is the world's leading outdoor health expert. His blog offers tips on outdoor safety and advice on how to handle wilderness emergencies.

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New Drugs for Treating Severe Frostbite

Chemical structure of prostacyclin
Chemical structure of prostacyclin
Prostacyclin (a derived form of a prostaglandin) is a bioactive compound that is believed to have beneficial effects in treating frostbite. It works by inhibiting a certain type of blood clotting caused by platelets, which are “sticky” blood components essential in the blood-clotting cascade. Tissue plasminogen activator (TPA) is a “clot buster” drug that is administered to break down (dissolve) a blood clot that has already formed.

These classes of drugs are important for physicians who wish to help their patients avoid undesirable blood clots (in the case of prostacyclin) or to dissolve them in order to make a viable path through blood vessels after a clot has formed (TPA). They are used mainly for prevention and treatment of cardiovascular disease, such as heart attacks and strokes. However, as time goes on, we will find additional indications for their use. Based on a recent clinical trial reported by Emmanuel Cauchy, MD and his colleagues from France (New England Journal of Medicine [NEJM] 364;2:189-190, 2011), we may soon be adding frostbite to the list of clinical situations for which these drugs are useful.

We know much, but not everything, about severe frostbite, which involves the freezing of tissue. The initial therapy is thawing the tissue. Beyond that, as the authors of the NEJM article point out, there are multiple methods used when attempting to improve the clinical situation, such as thinning the blood, using drugs to dilate blood vessels, taking anti-inflammatory drugs, inhaling hyperbaric oxygen, and so forth.

Between 1996 and 2008, Cauchy and colleagues treated 47 patients with severe frostbite incurred during mountaineering. The patients were treated with rapid tissue rewarming, then administration of aspirin and buflomedil (a drug that causes blood vessels to dilate). Then, in a randomized fashion, the patients received either (once again) aspirin and buflomedil; aspirin and iloprost (a prostacyclin drug); or aspirin, iloprost and a form of TPA. The patients were assessed after eight days with bone scans, and ultimately by the degree of amputation(s) required.

The addition of iloprost was found to be very beneficial; it was not clear whether or not the addition of the TPA drug was also helpful. On the basis of the results, the authors recommended that iloprost plus aspirin be used for severe frostbite, and that TPA be used at the discretion of the treating medical practitioners on a case-by-case basis. Iloprost is administered by inhalation or by intravenous infusion; it is not stated in this report, but I assume, that it was administered intravenously. 

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Tags: Hot & Cold

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Dr. Paul S. Auerbach is the world’s leading authority on wilderness medicine.