In acute limb ischemia, what is the immediate management step?

• A. Anticoagulation with intravenous heparin
• B. Thrombolytic therapy
• C. Surgical embolectomy
• D. Observation

Answer: (A)

In acute limb ischemia, the first and most important step is to start systemic anticoagulation with intravenous heparin right away. This protects the limb by preventing further propagation of the clot and limiting microvascular thrombosis, buying time to assess the extent of ischemia and arrange definitive revascularization. Heparin is given promptly unless there are contraindications such as active major bleeding or a high bleeding risk.

Definitive treatment to restore perfusion—such as surgical embolectomy or catheter-directed thrombolysis—depends on the cause, severity, and timing, but these are performed after anticoagulation is established. Observation would allow ongoing tissue death and is inappropriate in a threatened limb.