Iloprost therapy reduces amputation risk in severe frostbite: Canadian retrospective cohort study
By
O’Dochartaigh D, Douma MJ, Picard C, et al
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Summary
This retrospective cohort study evaluated iloprost therapy versus non-iloprost treatment for severe frostbite across two Canadian cities (Calgary and Edmonton) from November 2021 to April 2024. Among 257 patients with grades 2-4 extremity frostbite, iloprost was associated with a reduced likelihood of amputation (OR=0.49), particularly in grade 3 injuries (30% vs 52% amputation rates). Higher iloprost doses correlated with better digit salvage. Grade 4 frostbite still required amputations in over 80% of cases regardless of treatment, though iloprost reduced the number of digit segments amputated. Homelessness was a significant predictor of delayed ED presentation (OR=2.90). Adverse events occurred in 61% of iloprost patients, primarily headache.
Key quotes
· 5 pulledIloprost infusion was associated with a reduction in amputation rates in grade 3 and 4 frostbite with the greatest association seen in grade 3 cases.
Overall patients receiving iloprost were associated with reduced likelihood of any amputation (OR=0.49, 95% CI 0.25 to 0.96) and fewer digit amputations (p<0.001).
Greater iloprost dosage was associated with improved digit salvage.
Homelessness was found to be a significant predictor of delays in arrival to the ED after injury (p<0.001); OR=2.90 (95% CI 1.73 to 4.91).
Although over 80% of patients with grade 4 frostbite required amputations regardless of iloprost treatment, its use was associated with improved digit salvage, with 10% fewer digit segments requiring amputation.
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