What is the emergent treatment for arterial embolism or thrombosis presenting with pain, pallor, pulselessness, paresthesias, and paralysis?

• A. Heparin, emergency embolectomy-thrombectomy
• B. Thrombolytics
• C. IV nitroglycerin
• D. Warfarin

Answer: (A)

Acute limb-threatening arterial occlusion requires rapid restoration of blood flow. The best approach combines immediate anticoagulation with definitive revascularization. Starting heparin right away helps prevent the clot from growing and limits ongoing ischemia, buying time to fix the blockage. The urgent, definitive step is emergent embolectomy or thrombectomy to physically remove the clot and restore perfusion to the limb, which is crucial when there are signs of motor and sensory loss.

Thrombolytics might be considered in some cases, but they often take longer to work and carry bleeding risks, making them less ideal when the limb is in imminent danger. Nitrovasodilators like IV nitroglycerin aren’t addressing the underlying arterial occlusion in this scenario. Warfarin is useful for long-term prevention, not for immediate treatment of an acute occlusion.