A Rare Case of Acute Compartment Syndrome (ACS) Involving the Upper Limb in a Patient on Warfarin

Acute compartment syndrome (ACS) is an acute event characterized by increased pressure in the extremities where fascia encloses muscles, vessels, and nerves, leading to complications in tissue perfusion and, eventually, tissue necrosis and death. This is usually seen after trauma, crush injuries, and fractures. Similar events can also happen in the abdomen and lead to impaired perfusion in the abdominal organs. Hypovolemia, medications, and repeated or suboptimal diagnostic tests tend to worsen a pre-existing ACS, and the mainstay of its management is fasciotomy to prevent ischemic necrosis and rhabdomyolysis. Here we discuss a 64-year-old female with ACS involving the left upper limb, secondary to anticoagulation on warfarin and aspirin for atrial fibrillation. Her history was significant for peripheral vascular disease, above-knee amputation, and congestive heart failure. This article emphasizes the importance of early recognition and management of ACS to salvage limbs.