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Recurrent and persistent coagulopathy following pit viper envenomation.
Arch Intern Med. 1999 Apr 12; 159(7):706-10.AI

Abstract

BACKGROUND

Coagulation abnormalities following crotaline (pit viper) snakebite have traditionally been considered short-lived, but laboratory studies have rarely been reported beyond the first few days of treatment for envenomation. During the course of an antivenom clinical trial, we observed coagulation defects as late as 2 weeks following envenomation.

OBJECTIVES

To document and characterize the recurrence or persistence of coagulopathy among patients envenomed by pit vipers and treated with a Fab antivenom.

METHODS

Patients with moderate pit viper envenomation were enrolled in a multicenter, prospective clinical trial. A Fab-based antivenom preparation, antivenom polyvalent crotalid (ovine) Fab, was administered in all cases. Platelet count, fibrinogen level, presence of fibrin split products, prothrombin time, and partial thromboplastin time were determined before treatment and at standard intervals during the following 2 weeks.

RESULTS

Of 38 patients completing the study, 20 (53%) had recurrent, persistent, or late coagulopathy 2 to 14 days after envenomation. Thrombocytopenia occurred in patients with prior thrombocytopenia; hypofibrinogenemia occurred only in those with prior hypofibrinogenemia or positive fibrin split products. No patient experienced significant spontaneous bleeding. One patient with coagulopathy developed minor bleeding following minor surgery 12 days after envenomation.

CONCLUSIONS

Prolonged or recurrent coagulopathy may occur after envenomation by North American pit vipers. Patients treated with Fab-based antivenom may benefit from periodic rather than single-bolus dosing. Patients with coagulopathy should undergo close monitoring during the first 2 weeks after snakebite.

Authors+Show Affiliations

Department of Pediatrics, University of Arizona Health Sciences Center and Arizona Poison and Drug Information Center, Tucson 85724, USA.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't
Research Support, U.S. Gov't, P.H.S.

Language

eng

PubMed ID

10218750

Citation

Boyer, L V., et al. "Recurrent and Persistent Coagulopathy Following Pit Viper Envenomation." Archives of Internal Medicine, vol. 159, no. 7, 1999, pp. 706-10.
Boyer LV, Seifert SA, Clark RF, et al. Recurrent and persistent coagulopathy following pit viper envenomation. Arch Intern Med. 1999;159(7):706-10.
Boyer, L. V., Seifert, S. A., Clark, R. F., McNally, J. T., Williams, S. R., Nordt, S. P., Walter, F. G., & Dart, R. C. (1999). Recurrent and persistent coagulopathy following pit viper envenomation. Archives of Internal Medicine, 159(7), 706-10.
Boyer LV, et al. Recurrent and Persistent Coagulopathy Following Pit Viper Envenomation. Arch Intern Med. 1999 Apr 12;159(7):706-10. PubMed PMID: 10218750.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Recurrent and persistent coagulopathy following pit viper envenomation. AU - Boyer,L V, AU - Seifert,S A, AU - Clark,R F, AU - McNally,J T, AU - Williams,S R, AU - Nordt,S P, AU - Walter,F G, AU - Dart,R C, PY - 1999/4/28/pubmed PY - 1999/4/28/medline PY - 1999/4/28/entrez SP - 706 EP - 10 JF - Archives of internal medicine JO - Arch. Intern. Med. VL - 159 IS - 7 N2 - BACKGROUND: Coagulation abnormalities following crotaline (pit viper) snakebite have traditionally been considered short-lived, but laboratory studies have rarely been reported beyond the first few days of treatment for envenomation. During the course of an antivenom clinical trial, we observed coagulation defects as late as 2 weeks following envenomation. OBJECTIVES: To document and characterize the recurrence or persistence of coagulopathy among patients envenomed by pit vipers and treated with a Fab antivenom. METHODS: Patients with moderate pit viper envenomation were enrolled in a multicenter, prospective clinical trial. A Fab-based antivenom preparation, antivenom polyvalent crotalid (ovine) Fab, was administered in all cases. Platelet count, fibrinogen level, presence of fibrin split products, prothrombin time, and partial thromboplastin time were determined before treatment and at standard intervals during the following 2 weeks. RESULTS: Of 38 patients completing the study, 20 (53%) had recurrent, persistent, or late coagulopathy 2 to 14 days after envenomation. Thrombocytopenia occurred in patients with prior thrombocytopenia; hypofibrinogenemia occurred only in those with prior hypofibrinogenemia or positive fibrin split products. No patient experienced significant spontaneous bleeding. One patient with coagulopathy developed minor bleeding following minor surgery 12 days after envenomation. CONCLUSIONS: Prolonged or recurrent coagulopathy may occur after envenomation by North American pit vipers. Patients treated with Fab-based antivenom may benefit from periodic rather than single-bolus dosing. Patients with coagulopathy should undergo close monitoring during the first 2 weeks after snakebite. SN - 0003-9926 UR - https://www.unboundmedicine.com/medline/citation/10218750/Recurrent_and_persistent_coagulopathy_following_pit_viper_envenomation_ L2 - https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/vol/159/pg/706 DB - PRIME DP - Unbound Medicine ER -