Black Hills Doctor Saves Man’s Frostbitten Fingers with Clot Buster
Mar 27, 2019 09:00AM
● By MED Magazine
Some quick thinking, transatlantic collaboration, and the innovative use of a clot busting drug are credited with saving the frostbitten fingers of a 58-year-old Rapid City cook.
The man showed up at the Regional Health ED after having been locked out of his hotel room for hours in the dead of winter. By the time he arrived, the frostbite was severe. The case was further complicated by the fact that the patient was a lifelong smoker who suffered from peripheral vascular disease. Although the team did not know it at the time, he also had an occluded artery in his leg.
The ED doctor called on interventional cardiologist Bhaskar Purushottam, MD, who specializes in vascular medicine.
“We were really worried that he could lose all of his fingers,” says Dr. Purushottam. “I knew of this vascular treatment where you put a clot busting drug directly into the vessel, but I had not done it. There are only about 60 cases in the literature, so not a lot.”
Purushottam contacted his former mentor at Mount Sinai Hospital in New York, who contacted a colleague in Europe. Together, they helped him come up with a plan of action.
“I told the patient, ‘Look, I’ve never done this in Rapid City, but I’m very well trained and this is very similar to the procedure we do in the legs’,” says Purushottam. “It is essentially an intra arterial thrombolysis. The downside is, if you don’t use the appropriate dosing, you run a risk of serious bleeding. But in this case, I thought the opportunity to save the fingers outweighed the downsides.”
After a few hours of consideration, the patient agreed and the procedure was performed 24 hours after he had entered the ED.
Dr. Purushottam accessed the hands through an artery in the groin and used a wire to place a tiny catheter in each frostbitten fingers. Dye was injected, followed by a small dose of the clot dissolving drug.
“This drug has been well studied, so we know it does a great job,” says Dr. Purushottam. “But instead of using 40 to 70 milligrams as you would for ischemic stroke or heart attack, I barely used 20. You can use so much less because you are taking the medication directly to the clot.”
When the team discovered that the patient also had a clot in his leg, they performed the same procedure to open that blockage, too.
The patient’s remarkable recovery was recorded in daily photographs. Seven days after the procedure, he was discharged - with all of his fingers and all of his toes. “It makes me feel so happy for what I do,” says Purushottam. “He still has his fingers and his job.”
“If a patient comes in with frostbite and doesn’t have major complications, this should be considered, if possible,” Purushottam advises. “It appears to be safe and may prevent amputation, especially if performed within 24 hours.”
“The downside is, if you don’t use the appropriate dosing, you run a risk of serious bleeding. But in this case, I thought the opportunity to save the fingers outweighed the downsides.”