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Master Thesis

Essai contrôlé de l'iloprost et du rt-PA dans le traitement des gelures graves

Abstract : Many alternatives have been proposed for the treatment of frostbites. None has been assessed in prospective randomized trials. Conventionnal treatment often associates rapid rewarming, aspirin and alpha-adrenergic vasodilatators but have disappointing results in severe frostbites cases. The physiopathology incites to study two treatments : one based on the use of a prostacyclin analogue (iloprost) and the other based on thrombolytic therapy with rt-PA. Between 1996 and 2008 we randomly assigned 47 patients suffering, after rapid rewarming protocol, from at least one lesion concerning more than the whole distal phalanx. Each received for 8 days a treatment by aspirin associated with buflomedil, or with iloprost, or with iloprost + rt-PA. The risk of amputation in the buflomedil group was 60%. It was significantly lower in the iloprost group (0%) and iloprost + rt-PA group (19%). (p< ; 0,001 and p< ; 0,03 respectively, by Fisher's exact test). Those results were confirmed when frostbitten digits were studied independently, according to the severity (stages 3 and 4), the amount of time since rewarming ≤12h, ≤24h or ≤48h and the localization of the frosbite (feet or hands). However, our results do not rule out a possible positive effect of rt-PA when associated with iloprost. On the basis of these results, we recommend that in the treatment of severe frostbite a combination of aspirin and prostacyclin should be used. The addition of rt-PA should be considered on a case-by-case basis, depending on the severity of injury (at least stage 4 frostbite), the presence of any medical or traumatic contraindications, and the amount of time passed since rewarming.
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Master Thesis
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Submitted on : Thursday, May 17, 2012 - 6:20:23 PM
Last modification on : Tuesday, May 11, 2021 - 11:36:16 AM
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  • HAL Id : dumas-00618697, version 1

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Benoît Cheguillaume. Essai contrôlé de l'iloprost et du rt-PA dans le traitement des gelures graves. Médecine humaine et pathologie. 2011. ⟨dumas-00618697⟩

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