How is acute ischemic crisis treated
What can be done medically in patients presenting with acute ischemic crisis that is digit threatening?
- Step 1: put to rest in a warm and quiet environment in the hospital.
- Step 2: control pain. Chemical sympathectomy (digital lidocaine block) and consideration of narcotics.
- Step 3: start one of the following vasodilator therapies:
- • CCBs—amlodipine (5–10 mg) or nifedipine XL (30–60 mg) and titrate.
- • Intravenous prostaglandins—epoprostenol or iloprost if available.
- Step 4: antiplatelet therapy with aspirin 81 mg/day.
- Step 5: anticoagulation with heparin during acute crisis can be considered, especially if antiphospholipid antibodies are present.
