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Efficacy of antivenom against the procoagulant effect of Australian brown snake (Pseudonaja sp.) venom: in vivo and in vitro studies.
Toxicon 2007; 49(1):57-67T

Abstract

Snake venom induced consumption coagulopathy (VICC) is a common complication of snake bite due to prothrombin activators or thrombin-like enzymes in the venom. This study aimed to determine the efficacy and dose of antivenom for treating VICC in patients envenomed by brown snakes (Pseudonaja spp.), including in vitro coagulation studies. In serial blood samples from patients with brown snake envenoming, venom and antivenom concentrations were measured using enzyme immunoassays. In vitro mixtures of brown snake venom and antivenom were used to investigate antivenom binding, neutralisation of prothrombin activity, prevention of venom-mediated clotting and effect on thrombin generation parameters using a thrombinoscope. In 27 envenomed patients the median venom concentration was 20 ng/mL (Interquartile range[IQR]:12-44 ng/mL) prior to antivenom and was not detected after antivenom administration, including 9 patients given one vial. In vitro, 200 microg/mL of antivenom bound all free venom at venom concentrations seen in patients. In vitro prothrombinase activity of the venom (using a chromogenic substrate) was not neutralised by antivenom. However, for venom concentrations seen in humans, 100 microg/mL of antivenom prevented venom clotting activity in human plasma and 479 microg/mL neutralised procoagulant venom activity measured by triggering thrombin generation. One vial of antivenom appears to be sufficient to bind and neutralise all venom in patients with severe brown snake envenoming.

Authors+Show Affiliations

Tropical Toxinology Unit, Menzies School of Health Research, Charles Darwin University, Darwin, NSW, Australia. geoffrey.isbister@menzies.edu.auNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Evaluation Studies
Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

17055016

Citation

Isbister, Geoffrey K., et al. "Efficacy of Antivenom Against the Procoagulant Effect of Australian Brown Snake (Pseudonaja Sp.) Venom: in Vivo and in Vitro Studies." Toxicon : Official Journal of the International Society On Toxinology, vol. 49, no. 1, 2007, pp. 57-67.
Isbister GK, O'Leary MA, Schneider JJ, et al. Efficacy of antivenom against the procoagulant effect of Australian brown snake (Pseudonaja sp.) venom: in vivo and in vitro studies. Toxicon. 2007;49(1):57-67.
Isbister, G. K., O'Leary, M. A., Schneider, J. J., Brown, S. G., & Currie, B. J. (2007). Efficacy of antivenom against the procoagulant effect of Australian brown snake (Pseudonaja sp.) venom: in vivo and in vitro studies. Toxicon : Official Journal of the International Society On Toxinology, 49(1), pp. 57-67.
Isbister GK, et al. Efficacy of Antivenom Against the Procoagulant Effect of Australian Brown Snake (Pseudonaja Sp.) Venom: in Vivo and in Vitro Studies. Toxicon. 2007;49(1):57-67. PubMed PMID: 17055016.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Efficacy of antivenom against the procoagulant effect of Australian brown snake (Pseudonaja sp.) venom: in vivo and in vitro studies. AU - Isbister,Geoffrey K, AU - O'Leary,Margaret A, AU - Schneider,Jennifer J, AU - Brown,Simon G A, AU - Currie,Bart J, AU - ,, Y1 - 2006/09/17/ PY - 2006/06/08/received PY - 2006/09/12/accepted PY - 2006/10/24/pubmed PY - 2007/3/3/medline PY - 2006/10/24/entrez SP - 57 EP - 67 JF - Toxicon : official journal of the International Society on Toxinology JO - Toxicon VL - 49 IS - 1 N2 - Snake venom induced consumption coagulopathy (VICC) is a common complication of snake bite due to prothrombin activators or thrombin-like enzymes in the venom. This study aimed to determine the efficacy and dose of antivenom for treating VICC in patients envenomed by brown snakes (Pseudonaja spp.), including in vitro coagulation studies. In serial blood samples from patients with brown snake envenoming, venom and antivenom concentrations were measured using enzyme immunoassays. In vitro mixtures of brown snake venom and antivenom were used to investigate antivenom binding, neutralisation of prothrombin activity, prevention of venom-mediated clotting and effect on thrombin generation parameters using a thrombinoscope. In 27 envenomed patients the median venom concentration was 20 ng/mL (Interquartile range[IQR]:12-44 ng/mL) prior to antivenom and was not detected after antivenom administration, including 9 patients given one vial. In vitro, 200 microg/mL of antivenom bound all free venom at venom concentrations seen in patients. In vitro prothrombinase activity of the venom (using a chromogenic substrate) was not neutralised by antivenom. However, for venom concentrations seen in humans, 100 microg/mL of antivenom prevented venom clotting activity in human plasma and 479 microg/mL neutralised procoagulant venom activity measured by triggering thrombin generation. One vial of antivenom appears to be sufficient to bind and neutralise all venom in patients with severe brown snake envenoming. SN - 0041-0101 UR - https://www.unboundmedicine.com/medline/citation/17055016/Efficacy_of_antivenom_against_the_procoagulant_effect_of_Australian_brown_snake__Pseudonaja_sp___venom:_in_vivo_and_in_vitro_studies_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0041-0101(06)00343-6 DB - PRIME DP - Unbound Medicine ER -