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Failure of antivenom to improve recovery in Australian snakebite coagulopathy.
QJM. 2009 Aug; 102(8):563-8.QJM

Abstract

BACKGROUND

Venom-induced consumption coagulopathy (VICC) is an important feature of snake envenoming.

AIM

To investigate the effect of antivenom and fresh frozen plasma (FFP) on recovery of VICC in Australian elapid snake envenoming.

DESIGN

Prospective cohort study.

METHODS

Patients with VICC were included from the Australian Snakebite Project (ASP). Time to recovery of VICC (defined as time until INR <2) was investigated using a time to event analysis in WinBUGS. The model considered the effects of age, sex, snake type, time of antivenom after bite, antivenom dose and use of FFP within 4 h.

RESULTS

The study included 167 cases of VICC, median age being 41 [interquartile range (IQR): 28-53) years, and 130 (78%) were males. Antivenom was administered at a median of 3.6 (IQR: 2.2-5.6) h after the bite at a median dose of four vials (IQR: 2-6 vials). Thirteen patients received FFP within 4 h. Recovery of VICC occurred after a median of 14.4 (IQR: 11.5-17.5) h, and only the use of FFP within 4 h influenced the time to recovery. Neither antivenom dose nor time of antivenom administration had an effect on recovery of VICC. In patients administered with FFP, 12% [credible interval (CrI): 6-21%] and 81% (CrI: 61-94%) had recovered at 6 and 12 h, respectively, vs 2.5% (CrI: 1.5-4%) and 28% (CrI: 22-34%) not receiving FFP.

DISCUSSION

Antivenom did not appear to be effective for the coagulopathy in snake envenoming in Australia. FFP appeared to shorten the time of VICC recovery.

Authors+Show Affiliations

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

Pub Type(s)

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

Language

eng

PubMed ID

19570990

Citation

Isbister, G K., et al. "Failure of Antivenom to Improve Recovery in Australian Snakebite Coagulopathy." QJM : Monthly Journal of the Association of Physicians, vol. 102, no. 8, 2009, pp. 563-8.
Isbister GK, Duffull SB, Brown SG, et al. Failure of antivenom to improve recovery in Australian snakebite coagulopathy. QJM. 2009;102(8):563-8.
Isbister, G. K., Duffull, S. B., & Brown, S. G. (2009). Failure of antivenom to improve recovery in Australian snakebite coagulopathy. QJM : Monthly Journal of the Association of Physicians, 102(8), 563-8. https://doi.org/10.1093/qjmed/hcp081
Isbister GK, et al. Failure of Antivenom to Improve Recovery in Australian Snakebite Coagulopathy. QJM. 2009;102(8):563-8. PubMed PMID: 19570990.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Failure of antivenom to improve recovery in Australian snakebite coagulopathy. AU - Isbister,G K, AU - Duffull,S B, AU - Brown,S G A, AU - ,, Y1 - 2009/07/01/ PY - 2009/7/3/entrez PY - 2009/7/3/pubmed PY - 2010/1/12/medline SP - 563 EP - 8 JF - QJM : monthly journal of the Association of Physicians JO - QJM VL - 102 IS - 8 N2 - BACKGROUND: Venom-induced consumption coagulopathy (VICC) is an important feature of snake envenoming. AIM: To investigate the effect of antivenom and fresh frozen plasma (FFP) on recovery of VICC in Australian elapid snake envenoming. DESIGN: Prospective cohort study. METHODS: Patients with VICC were included from the Australian Snakebite Project (ASP). Time to recovery of VICC (defined as time until INR <2) was investigated using a time to event analysis in WinBUGS. The model considered the effects of age, sex, snake type, time of antivenom after bite, antivenom dose and use of FFP within 4 h. RESULTS: The study included 167 cases of VICC, median age being 41 [interquartile range (IQR): 28-53) years, and 130 (78%) were males. Antivenom was administered at a median of 3.6 (IQR: 2.2-5.6) h after the bite at a median dose of four vials (IQR: 2-6 vials). Thirteen patients received FFP within 4 h. Recovery of VICC occurred after a median of 14.4 (IQR: 11.5-17.5) h, and only the use of FFP within 4 h influenced the time to recovery. Neither antivenom dose nor time of antivenom administration had an effect on recovery of VICC. In patients administered with FFP, 12% [credible interval (CrI): 6-21%] and 81% (CrI: 61-94%) had recovered at 6 and 12 h, respectively, vs 2.5% (CrI: 1.5-4%) and 28% (CrI: 22-34%) not receiving FFP. DISCUSSION: Antivenom did not appear to be effective for the coagulopathy in snake envenoming in Australia. FFP appeared to shorten the time of VICC recovery. SN - 1460-2393 UR - https://www.unboundmedicine.com/medline/citation/19570990/Failure_of_antivenom_to_improve_recovery_in_Australian_snakebite_coagulopathy_ L2 - https://academic.oup.com/qjmed/article-lookup/doi/10.1093/qjmed/hcp081 DB - PRIME DP - Unbound Medicine ER -