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Current treatment for venom-induced consumption coagulopathy resulting from snakebite.
PLoS Negl Trop Dis 2014; 8(10):e3220PN

Abstract

Venomous snakebite is considered the single most important cause of human injury from venomous animals worldwide. Coagulopathy is one of the commonest important systemic clinical syndromes and can be complicated by serious and life-threatening haemorrhage. Venom-induced consumption coagulopathy (VICC) is the commonest coagulopathy resulting from snakebite and occurs in envenoming by Viperid snakes, certain elapids, including Australian elapids, and a few Colubrid (rear fang) snakes. Procoagulant toxins activate the clotting pathway, causing a broad range of factor deficiencies depending on the particular procoagulant toxin in the snake venom. Diagnosis and monitoring of coagulopathy is problematic, particularly in resource-poor countries where further research is required to develop more reliable, cheap clotting tests. MEDLINE and EMBASE up to September 2013 were searched to identify clinical studies of snake envenoming with VICC. The UniPort database was searched for coagulant snake toxins. Despite preclinical studies demonstrating antivenom binding toxins (efficacy), there was less evidence to support clinical effectiveness of antivenom for VICC. There were no placebo-controlled trials of antivenom for VICC. There were 25 randomised comparative trials of antivenom for VICC, which compared two different antivenoms (ten studies), three different antivenoms (four), two or three different doses or repeat doses of antivenom (five), heparin treatment and antivenom (five), and intravenous immunoglobulin treatment and antivenom (one). There were 13 studies that compared two groups in which there was no randomisation, including studies with historical controls. There have been numerous observational studies of antivenom in VICC but with no comparison group. Most of the controlled trials were small, did not use the same method for assessing coagulopathy, varied the dose of antivenom, and did not provide complete details of the study design (primary outcomes, randomisation, and allocation concealment). Non-randomised trials including comparison groups without antivenom showed that antivenom was effective for some snakes (e.g., Echis), but not others (e.g., Australasian elapids). Antivenom is the major treatment for VICC, but there is currently little high-quality evidence to support effectiveness. Antivenom is not risk free, and adverse reactions can be quite common and potentially severe. Studies of heparin did not demonstrate it improved outcomes in VICC. Fresh frozen plasma appeared to speed the recovery of coagulopathy and should be considered in bleeding patients.

Authors+Show Affiliations

School of Medicine and Public Health, University of Newcastle, New South Wales, Australia; South Asian Clinical Toxicology Research Collaboration, Peradeniya, Sri Lanka; Department of Biochemistry, Faculty of Medicine, University of Peradeniya, Peradeniya, Sri Lanka.School of Medicine and Public Health, University of Newcastle, New South Wales, Australia; South Asian Clinical Toxicology Research Collaboration, Peradeniya, Sri Lanka; Department of Clinical Toxicology and Pharmacology, Calvary Mater Newcastle, Newcastle, New South Wales, Australia.

Pub Type(s)

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

Language

eng

PubMed ID

25340841

Citation

Maduwage, Kalana, and Geoffrey K. Isbister. "Current Treatment for Venom-induced Consumption Coagulopathy Resulting From Snakebite." PLoS Neglected Tropical Diseases, vol. 8, no. 10, 2014, pp. e3220.
Maduwage K, Isbister GK. Current treatment for venom-induced consumption coagulopathy resulting from snakebite. PLoS Negl Trop Dis. 2014;8(10):e3220.
Maduwage, K., & Isbister, G. K. (2014). Current treatment for venom-induced consumption coagulopathy resulting from snakebite. PLoS Neglected Tropical Diseases, 8(10), pp. e3220. doi:10.1371/journal.pntd.0003220.
Maduwage K, Isbister GK. Current Treatment for Venom-induced Consumption Coagulopathy Resulting From Snakebite. PLoS Negl Trop Dis. 2014;8(10):e3220. PubMed PMID: 25340841.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Current treatment for venom-induced consumption coagulopathy resulting from snakebite. AU - Maduwage,Kalana, AU - Isbister,Geoffrey K, Y1 - 2014/10/23/ PY - 2014/10/24/entrez PY - 2014/10/24/pubmed PY - 2015/12/15/medline SP - e3220 EP - e3220 JF - PLoS neglected tropical diseases JO - PLoS Negl Trop Dis VL - 8 IS - 10 N2 - Venomous snakebite is considered the single most important cause of human injury from venomous animals worldwide. Coagulopathy is one of the commonest important systemic clinical syndromes and can be complicated by serious and life-threatening haemorrhage. Venom-induced consumption coagulopathy (VICC) is the commonest coagulopathy resulting from snakebite and occurs in envenoming by Viperid snakes, certain elapids, including Australian elapids, and a few Colubrid (rear fang) snakes. Procoagulant toxins activate the clotting pathway, causing a broad range of factor deficiencies depending on the particular procoagulant toxin in the snake venom. Diagnosis and monitoring of coagulopathy is problematic, particularly in resource-poor countries where further research is required to develop more reliable, cheap clotting tests. MEDLINE and EMBASE up to September 2013 were searched to identify clinical studies of snake envenoming with VICC. The UniPort database was searched for coagulant snake toxins. Despite preclinical studies demonstrating antivenom binding toxins (efficacy), there was less evidence to support clinical effectiveness of antivenom for VICC. There were no placebo-controlled trials of antivenom for VICC. There were 25 randomised comparative trials of antivenom for VICC, which compared two different antivenoms (ten studies), three different antivenoms (four), two or three different doses or repeat doses of antivenom (five), heparin treatment and antivenom (five), and intravenous immunoglobulin treatment and antivenom (one). There were 13 studies that compared two groups in which there was no randomisation, including studies with historical controls. There have been numerous observational studies of antivenom in VICC but with no comparison group. Most of the controlled trials were small, did not use the same method for assessing coagulopathy, varied the dose of antivenom, and did not provide complete details of the study design (primary outcomes, randomisation, and allocation concealment). Non-randomised trials including comparison groups without antivenom showed that antivenom was effective for some snakes (e.g., Echis), but not others (e.g., Australasian elapids). Antivenom is the major treatment for VICC, but there is currently little high-quality evidence to support effectiveness. Antivenom is not risk free, and adverse reactions can be quite common and potentially severe. Studies of heparin did not demonstrate it improved outcomes in VICC. Fresh frozen plasma appeared to speed the recovery of coagulopathy and should be considered in bleeding patients. SN - 1935-2735 UR - https://www.unboundmedicine.com/medline/citation/25340841/Current_treatment_for_venom_induced_consumption_coagulopathy_resulting_from_snakebite_ L2 - http://dx.plos.org/10.1371/journal.pntd.0003220 DB - PRIME DP - Unbound Medicine ER -