Management of severe frostbite with iloprost, alteplase and heparin: a Yukon case series

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Figure 1:
Yukon Frostbite Protocol. Note: PTT = partial thromboplastin time.
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Figure 2:
Frostbite severity by local environmental temperature at the time of the injury.
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Figure 3:
Frostbite severity by precipitating event.
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Figure 4:
Mean time from emergency department presentation to iloprost treatment. No iloprost was given in 2016. Error bars = standard deviation.

Table 1:

Demographic and clinical characteristics of patients with grade 2–4 frostbite

Characteristic	No. (%) of patients^* n = 22
Age, mean ± SD, yr	39 ± 14
Sex, male	17 (77)
Comorbidities
Tobacco smoking	7 (32)
Alcohol use disorder	7 (32)
Local environmental temperature at time of injury, mean ± SD, °C	−31 ± 10
Body temperature at presentation to emergency department, mean ± SD, °C	36.2 ± 1.6
Duration of cold exposure, mean ± SD, h	20 ± 18
Freeze–thaw–refreeze cycle	2 (9)
Precipitating event
Sport	10 (45)
Alcohol use	6 (27)
Car accident/breakdown	3 (14)
Work/labour	2 (9)
Psychiatric disorder	1 (4)
Frostbite grade
2	10 (45)
3	5 (23)
4	7 (32)
Limbs involved
Feet	12 (54)
Hands	6 (27)
Feet and hands	4 (18)

Table 2:

Treatment and adverse drug reactions

Variable	No. (%) of patients
Treatment
Rapid rewarming	13 (59)
Iloprost only	9 (41)
Iloprost, alteplase and heparin	4 (18)
Passive rewarming	9 (41)
Iloprost only	8 (36)
Iloprost, alteplase and heparin	1 (4)
Treatment adjunct
Topically administered aloe vera	19 (86)
Scheduled orally administered ibuprofen	22 (100)
No. of iloprost doses received
1	2 (9)
3	3 (14)
4	1 (5)
5	16 (73)
Alteplase dosing (n = 5)
15 mg intravenously over 2 min, then 0.75 mg/kg (maximum 50 mg) over 30 min, then 0.5 mg/kg (maximum 35 mg) over 60 min	1 (20)
0.15 mg/kg over 15 min, then 0.15 mg/kg per hour intravenously for 6 h^*	4 (80)
Adverse drug reactions
Iloprost
Headache	11 (50)
Flushing	8 (36)
Tachycardia (heart rate > 100 beats/min)	8 (36)
Nausea	6 (27)
Vomiting	2 (9)
Dizziness	2 (9)
Bleeding	1 (4)
Hypotension (blood pressure < 90/50 mm Hg)	1 (4)
Alteplase (n = 5)
Acute intramuscular hemorrhage	1 (20)
Bleeding from wounds	1 (20)