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Factor deficiencies in venom-induced consumption coagulopathy resulting from Australian elapid envenomation: Australian Snakebite Project (ASP-10).
J Thromb Haemost. 2010 Nov; 8(11):2504-13.JT

Abstract

BACKGROUND

Limited information exists on the dynamics of hemostasis in patients with venom-induced consumption coagulopathy (VICC) from snake envenomation.

OBJECTIVE

The aim of the present study was to investigate specific factor deficiencies and their time course in Australasian elapid envenomation.

METHODS

We measured coagulation parameters and factor concentrations in patients recruited to the Australian Snakebite Project, an observational cohort study. There were 112 patients with complete VICC, defined as an international normalized ratio (INR) > 3, and 18 with partial VICC. Serial citrated plasma samples were collected from 0.5 to 60 h post-bite. INR, activated partial thromboplastin time (aPTT), coagulation factors (F)I, II, V, VII, VIII, IX, X, von Willebrand factor antigen (VWF:Ag) and D-dimer concentrations were measured.

RESULTS

Complete VICC was characterized by near/total depletion of fibrinogen, FV and FVIII, with an INR and aPTT that exceeded the upper limits of detection, within 2 h of snakebite. Prothrombin levels never fell below 60% of normal, suggesting that the toxins were rapidly eliminated or inactivated and re-synthesis of clotting factors occurred irrespective of antivenom. Partial VICC caused limited depletion of fibrinogen and FV, and almost complete consumption of FVIII. Onset of VICC was more rapid with brown snake (Pseudonaja spp.) venom, which contains a group C prothrombin activator toxin, compared with the tiger snake group, which contains a group D prothrombin activator toxin and requires human FVa formation. Resolution of VICC occurred within 24-36 h irrespective of snake type.

CONCLUSIONS

These results suggest that Australasian elapid prothrombin activators have a potent but short duration of action. Antivenom is unlikely to be administered in time to prevent VICC.

Authors+Show Affiliations

School of Medicine and Public Health, University of Newcastle, NSW, Australia. geoff.isbister@gmail.comNo 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

Language

eng

PubMed ID

20831619

Citation

Isbister, G K., et al. "Factor Deficiencies in Venom-induced Consumption Coagulopathy Resulting From Australian Elapid Envenomation: Australian Snakebite Project (ASP-10)." Journal of Thrombosis and Haemostasis : JTH, vol. 8, no. 11, 2010, pp. 2504-13.
Isbister GK, Scorgie FE, O'Leary MA, et al. Factor deficiencies in venom-induced consumption coagulopathy resulting from Australian elapid envenomation: Australian Snakebite Project (ASP-10). J Thromb Haemost. 2010;8(11):2504-13.
Isbister, G. K., Scorgie, F. E., O'Leary, M. A., Seldon, M., Brown, S. G., & Lincz, L. F. (2010). Factor deficiencies in venom-induced consumption coagulopathy resulting from Australian elapid envenomation: Australian Snakebite Project (ASP-10). Journal of Thrombosis and Haemostasis : JTH, 8(11), 2504-13. https://doi.org/10.1111/j.1538-7836.2010.04050.x
Isbister GK, et al. Factor Deficiencies in Venom-induced Consumption Coagulopathy Resulting From Australian Elapid Envenomation: Australian Snakebite Project (ASP-10). J Thromb Haemost. 2010;8(11):2504-13. PubMed PMID: 20831619.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Factor deficiencies in venom-induced consumption coagulopathy resulting from Australian elapid envenomation: Australian Snakebite Project (ASP-10). AU - Isbister,G K, AU - Scorgie,F E, AU - O'Leary,M A, AU - Seldon,M, AU - Brown,S G A, AU - Lincz,L F, AU - ,, PY - 2010/9/14/entrez PY - 2010/9/14/pubmed PY - 2011/5/24/medline SP - 2504 EP - 13 JF - Journal of thrombosis and haemostasis : JTH JO - J. Thromb. Haemost. VL - 8 IS - 11 N2 - BACKGROUND: Limited information exists on the dynamics of hemostasis in patients with venom-induced consumption coagulopathy (VICC) from snake envenomation. OBJECTIVE: The aim of the present study was to investigate specific factor deficiencies and their time course in Australasian elapid envenomation. METHODS: We measured coagulation parameters and factor concentrations in patients recruited to the Australian Snakebite Project, an observational cohort study. There were 112 patients with complete VICC, defined as an international normalized ratio (INR) > 3, and 18 with partial VICC. Serial citrated plasma samples were collected from 0.5 to 60 h post-bite. INR, activated partial thromboplastin time (aPTT), coagulation factors (F)I, II, V, VII, VIII, IX, X, von Willebrand factor antigen (VWF:Ag) and D-dimer concentrations were measured. RESULTS: Complete VICC was characterized by near/total depletion of fibrinogen, FV and FVIII, with an INR and aPTT that exceeded the upper limits of detection, within 2 h of snakebite. Prothrombin levels never fell below 60% of normal, suggesting that the toxins were rapidly eliminated or inactivated and re-synthesis of clotting factors occurred irrespective of antivenom. Partial VICC caused limited depletion of fibrinogen and FV, and almost complete consumption of FVIII. Onset of VICC was more rapid with brown snake (Pseudonaja spp.) venom, which contains a group C prothrombin activator toxin, compared with the tiger snake group, which contains a group D prothrombin activator toxin and requires human FVa formation. Resolution of VICC occurred within 24-36 h irrespective of snake type. CONCLUSIONS: These results suggest that Australasian elapid prothrombin activators have a potent but short duration of action. Antivenom is unlikely to be administered in time to prevent VICC. SN - 1538-7836 UR - https://www.unboundmedicine.com/medline/citation/20831619/Factor_deficiencies_in_venom_induced_consumption_coagulopathy_resulting_from_Australian_elapid_envenomation:_Australian_Snakebite_Project__ASP_10__ L2 - https://doi.org/10.1111/j.1538-7836.2010.04050.x DB - PRIME DP - Unbound Medicine ER -