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Acute Limb Ischaemia — RACP Adult Medicine MCQ

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ModerateEmergency MedicineAcute Limb IschaemiaRACP Adult Medicine

A 72-year-old man with known atrial fibrillation on apixaban 5 mg BD develops acute limb ischaemia of his left leg (absent femoral pulse, pale, cold, pulseless, paraesthetic). What is the most urgent management?

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Correct answer: C — Increase apixaban dose

Acute limb ischaemia from arterial embolism (most commonly cardioembolism in AF) is a surgical emergency. The '6 Ps' (pain, pallor, pulselessness, paraesthesia, paralysis, poikilothermia) indicate a threatened limb. Immediate IV UFH bolus (to prevent clot propagation) and urgent vascular surgery consultation for surgical embolectomy (Fogarty catheter) or catheter-directed thrombolysis are required. The Rutherford classification guides urgency – paralysis and sensory loss indicate category IIb (immediately threatened), requiring urgent revascularisation within 6 hours.

Reference: eTG – 2025 – Cardiovascular; ESVS – 2020 – Acute Limb Ischaemia Guidelines