Emergent pharmacological management of ulnar artery thrombosis

Background

Ulnar artery thrombosis (UAT) refers to occlusion of the ulnar artery due to a blood clot and is a subcategory of hypothenar hammer syndrome (HHS). We present a case of right ulnar artery thrombosis that was pharmacologically managed in the Emergency Department (ED) and inpatient ward.

Case report

A 52-year-old male with a history of anemia and elevated ferritin presented to the ED with a 5-day history of skin discoloration, numbness, and tingling of his right 5th finger. CT angiogram showed a focal 1.5 cm-long thrombotic ulnar artery occlusion at the palmar bifurcation and embolic occlusion of the 5th digital arteries in the finger. Following consultation with vascular surgery, he was given intravenous heparin, transitioned to apixaban for lifelong anticoagulation therapy, and discharged following the placement of a Zio^Ⓡ patch.

Why should an emergency physician be aware of this?

The patient's career involving manual labor, elevated ferritin, and smoking history may have been risk factors for UAT development. Our case illustrates the value of interdisciplinary collaboration and conservative management in low-acuity cases of UAT.