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Late hemotoxicity following North American rattlesnake envenomation treated with crotalidae immune F(ab')2 (equine) antivenom and crotalidae immune polyvalent Fab (ovine) antivenom reported to the North American Snakebite Sub-registry.
Clin Toxicol (Phila). 2022 07; 60(7):838-842.CT

Abstract

INTRODUCTION

Late hemotoxicity is common following rattlesnake envenomation treated with crotalidae immune polyvalent Fab (ovine) (FabAV). Initial clinical trials showed crotalidae immune F(ab')2 (equine) (Fab2AV) to be superior to FabAV in preventing late hemotoxicity, but this effect has not been demonstrated in broader populations. This study investigated late hemotoxicity in patients receiving Fab2AV or FabAV after rattlesnake envenomation.

METHODS

This is a retrospective analysis of prospectively collected data from patients with snakebite reported to the ToxIC North American Snakebite Registry (NASBR) between January 1, 2019, and December 31, 2020. Inclusion criteria were rattlesnake envenomation and administration of antivenom. Patients were excluded if they received more than one type of antivenom. The primary outcome was occurrence of late hemotoxicity (platelets ≤120 k/mm3 or fibrinogen ≤170 mg/dL) in patients receiving Fab2AV and FabAV. Data collected included demographics, envenomation characteristics, laboratory values, and treatment administered. Statistics including t-test and Fisher's exact test were used.

RESULTS

A total of 201 rattlesnake envenomated patients receiving antivenom were reported to the NASBR in the study period; 144 were included. 49 received Fab2AV alone, 45 received FabAV alone and 50 received both antivenoms. Baseline patient and envenomation characteristics were similar between the groups. Late hemotoxicity occurred in 2/49 patients in the Fab2AV group (4% (95% CI 0.7-12.6)) and in 19/45 patients in the FabAV group (42% (95% CI 28.4-59.0); absolute risk reduction 39.1% (95% CI 21.2-46.2) (p = 0.001). On follow up, 0 patients (0%) receiving Fab2AV were retreated with antivenom; 4 patients (9%) receiving FabAV were retreated (p = 0.049).

CONCLUSIONS

In the North American Snakebite Registry, late hemotoxicity was less common in rattlesnake envenomated patients treated with Fab2AV compared to FabAV.

Authors+Show Affiliations

Department of Emergency Medicine, Banner-University Medical Center Phoenix, Phoenix, AZ, USA. The University of Arizona College of Medicine-Phoenix, Phoenix, AZ, USA.Department of Emergency Medicine, Rhode Island Hospital, Brown University Emergency Medicine Residency, RI, Providence.Department of Emergency Medicine, Banner-University Medical Center Phoenix, Phoenix, AZ, USA. The University of Arizona College of Medicine-Phoenix, Phoenix, AZ, USA.Department of Medical Toxicology, Rocky Mountain Poison and Drug Center, Denver, CO, USA. University of Colorado Denver School of Medicine, Aurora, CO, USA.Department of Emergency Medicine, Loma Linda University School of Medicine, Loma Linda, CA, USA.Department of Emergency Medicine, Banner-University Medical Center Phoenix, Phoenix, AZ, USA. The University of Arizona College of Medicine-Phoenix, Phoenix, AZ, USA.No affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

35261320

Citation

Spyres, Meghan Beth, et al. "Late Hemotoxicity Following North American Rattlesnake Envenomation Treated With Crotalidae Immune F(ab')2 (equine) Antivenom and Crotalidae Immune Polyvalent Fab (ovine) Antivenom Reported to the North American Snakebite Sub-registry." Clinical Toxicology (Philadelphia, Pa.), vol. 60, no. 7, 2022, pp. 838-842.
Spyres MB, Padilla GK, Gerkin RD, et al. Late hemotoxicity following North American rattlesnake envenomation treated with crotalidae immune F(ab')2 (equine) antivenom and crotalidae immune polyvalent Fab (ovine) antivenom reported to the North American Snakebite Sub-registry. Clin Toxicol (Phila). 2022;60(7):838-842.
Spyres, M. B., Padilla, G. K., Gerkin, R. D., Hoyte, C. O., Wolk, B. J., & Ruha, A. M. (2022). Late hemotoxicity following North American rattlesnake envenomation treated with crotalidae immune F(ab')2 (equine) antivenom and crotalidae immune polyvalent Fab (ovine) antivenom reported to the North American Snakebite Sub-registry. Clinical Toxicology (Philadelphia, Pa.), 60(7), 838-842. https://doi.org/10.1080/15563650.2022.2042550
Spyres MB, et al. Late Hemotoxicity Following North American Rattlesnake Envenomation Treated With Crotalidae Immune F(ab')2 (equine) Antivenom and Crotalidae Immune Polyvalent Fab (ovine) Antivenom Reported to the North American Snakebite Sub-registry. Clin Toxicol (Phila). 2022;60(7):838-842. PubMed PMID: 35261320.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Late hemotoxicity following North American rattlesnake envenomation treated with crotalidae immune F(ab')2 (equine) antivenom and crotalidae immune polyvalent Fab (ovine) antivenom reported to the North American Snakebite Sub-registry. AU - Spyres,Meghan Beth, AU - Padilla,Gabriel K, AU - Gerkin,Richard D, AU - Hoyte,Christopher O, AU - Wolk,Brian Joseph, AU - Ruha,Anne-Michelle, AU - ,, Y1 - 2022/03/09/ PY - 2022/3/10/pubmed PY - 2022/7/9/medline PY - 2022/3/9/entrez KW - Rattlesnake KW - antivenom KW - envenomation KW - hemotoxicity SP - 838 EP - 842 JF - Clinical toxicology (Philadelphia, Pa.) JO - Clin Toxicol (Phila) VL - 60 IS - 7 N2 - INTRODUCTION: Late hemotoxicity is common following rattlesnake envenomation treated with crotalidae immune polyvalent Fab (ovine) (FabAV). Initial clinical trials showed crotalidae immune F(ab')2 (equine) (Fab2AV) to be superior to FabAV in preventing late hemotoxicity, but this effect has not been demonstrated in broader populations. This study investigated late hemotoxicity in patients receiving Fab2AV or FabAV after rattlesnake envenomation. METHODS: This is a retrospective analysis of prospectively collected data from patients with snakebite reported to the ToxIC North American Snakebite Registry (NASBR) between January 1, 2019, and December 31, 2020. Inclusion criteria were rattlesnake envenomation and administration of antivenom. Patients were excluded if they received more than one type of antivenom. The primary outcome was occurrence of late hemotoxicity (platelets ≤120 k/mm3 or fibrinogen ≤170 mg/dL) in patients receiving Fab2AV and FabAV. Data collected included demographics, envenomation characteristics, laboratory values, and treatment administered. Statistics including t-test and Fisher's exact test were used. RESULTS: A total of 201 rattlesnake envenomated patients receiving antivenom were reported to the NASBR in the study period; 144 were included. 49 received Fab2AV alone, 45 received FabAV alone and 50 received both antivenoms. Baseline patient and envenomation characteristics were similar between the groups. Late hemotoxicity occurred in 2/49 patients in the Fab2AV group (4% (95% CI 0.7-12.6)) and in 19/45 patients in the FabAV group (42% (95% CI 28.4-59.0); absolute risk reduction 39.1% (95% CI 21.2-46.2) (p = 0.001). On follow up, 0 patients (0%) receiving Fab2AV were retreated with antivenom; 4 patients (9%) receiving FabAV were retreated (p = 0.049). CONCLUSIONS: In the North American Snakebite Registry, late hemotoxicity was less common in rattlesnake envenomated patients treated with Fab2AV compared to FabAV. SN - 1556-9519 UR - https://www.unboundmedicine.com/medline/citation/35261320/Late_hemotoxicity_following_North_American_rattlesnake_envenomation_treated_with_crotalidae_immune_F_ab'_2__equine__antivenom_and_crotalidae_immune_polyvalent_Fab__ovine__antivenom_reported_to_the_North_American_Snakebite_Sub_registry_ L2 - https://www.tandfonline.com/doi/full/10.1080/15563650.2022.2042550 DB - PRIME DP - Unbound Medicine ER -