Journal Article

Failure of antivenom to improve recovery in Australian snakebite coagulopathy

G.K. Isbister, S.B. Duffull and S.G.A. Brown

in QJM: An International Journal of Medicine

Published on behalf of Association of Physicians of Great Britain and Ireland

Volume 102, issue 8, pages 563-568
Published in print August 2009 | ISSN: 1460-2725
Published online July 2009 | e-ISSN: 1460-2393 | DOI: https://dx.doi.org/10.1093/qjmed/hcp081
Failure of antivenom to improve recovery in Australian snakebite coagulopathy

Show Summary Details

Preview

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.

Journal Article.  2584 words.  Illustrated.

Subjects: Medicine and Health

Full text: subscription required

How to subscribe Recommend to my Librarian

Users without a subscription are not able to see the full content. Please, subscribe or login to access all content.