Trombolisis dalam Manajemen Frostbite

Oleh :

dr.Eva Naomi Oretla

Trombolisis agresif saat ini kerap digunakan dalam manajemen frostbite atau radang dingin. Frostbite merupakan cedera jaringan yang diakibatkan oleh adanya paparan dingin. Sebanyak 90% kasus frostbite terjadi pada ekstremitas distal. Derajat keparahan berkisar dari kondisi ringan, superfisial, hingga cedera pembekuan pada jaringan dalam yang parah. Radang dingin yang parah (severe frostbite) dapat menyebabkan amputasi ekstremitas.[1-3]

Selama beberapa dekade terakhir terdapat perubahan pada penatalaksanaan frostbite. Terjadi pergeseran dari terapi suportif dan observasi, ke intervensi medis awal dan agresif dengan pemberian agen trombolitik (trombolisis).[1,3,4] Penggunaan trombolisis dilaporkan dapat mengurangi insiden dan morbiditas terkait dengan kehilangan jaringan (amputasi).[1,5-7]

Peran Trombolisis pada Frostbite

(Konten ini khusus untuk dokter. Registrasi untuk baca selengkapnya)

Referensi

1. Drinane J, Heiman A J, et al. Thrombolytic Salvage of the Frostbitten Upper Extremity: A Systematic Review. HAND. 2020;00(0):1-8 DOI: 10.1177/1558944720940065
2. Khan S L, Parikh R, et al. Barriers to frostbite treatment at an academic medical center. American Journal of Emergency Medicine. 2019;37:1601.e3–1601.e5 DOI: https://doi.org/10.1016/j.ajem.2019.05.012
3. Linford A, Valtonen J, et al. The evolution of the Helsinki frostbite management protocol. Burns. 2017;43:1455-1463 DOI: http://dx.doi.org/10.1016/j.burns.2017.04.016
4. Paine R E, Turner E N, et al. Protocoled thrombolytic therapy for frostbite improves phalangeal salvage rates. Burns & Trauma. 2020;8(008):1-9 doi: 10.1093/burnst/tkaa008
5. Heard J, Shamrock A, et al. Thrombolytic Use in Management of Frostbite Injuries: Eight Year Retrospective Review at a Single Institution. American Burn Association. 2020;0:1-18
6. Drinane J, Kotamurti V, et al. Thrombolytic Salvage of Threatened Frostbitten Extremities and Digits: A Systematic Review. American Burn Association. 2020;0:1-9 doi:10.1093/jbcr/irz097
7. Tavri S, Ganguli S, et al.Catheter-Directed Intraarterial Thrombolysis as Part of a Multidisciplinary Management Protocol of Frostbite Injury. J Vasc Interv Radiol. 2016;27:1228–1235
8. A Iqbal, A Jan, et al. Efficacy of Leeching in Frostbite. Clin Dermatol J. 2019;4(4):1-9 DOI: 10.23880/cdoaj-1600019
9. Poole A, et al. Management of severe frostbite with iloprost, alteplase and heparin: a Yukon case series. CMAJ Open 2021;9(2):E585-E591 DOI:10.9778/cmajo.20200214
10. Mullen M, Zachary T, et al. Thrombolysis for Frostbite: A Case Study and Clinical Considerations. Journal of Radiology Nursing. 2019;38:237-240 DOI: https://doi.org/10.1016/j.jradnu.2019.10.001
11. Hutchison R L, et al. The Use of tPA in the Treatment of Frostbite: A Systematic Review. HAND. 2019:14(1):13–18 DOI: 10.1177/1558944718800731
12. Hickey S, Whitson A, et al. Guidelines for Thrombolytic Therapy for Frostbite. American Burn Association. 2020;0:1-8 doi:10.1093/jbcr/irz148
13. Lee J, Higgins M C S S. What Interventional Radiologists Need to Know About Managing Severe Frostbite: A Meta-Analysis of Thrombolytic Therapy. AJR. 2020;214:1–8 doi.org/10.2214/AJR.19.21592
14. Gao Y, Wang F, et al. Research progress in the pathogenic mechanisms and imaging of severe frostbite. European Journal of Radiology. 2021;137:1-8 DOI: https://doi.org/10.1016/j.ejrad.2021.109605
15. Millet JD, Levi B, et al. Frostbite: Spectrum of Imaging Findings and Guidelines for Management. RG. 2016;36(7):2154-2169 DOI:10.1148/rg.2016160045