Case Report: Management of Pit Viper Envenoming without Antivenom: A Case Series

Bhatt, Navin; Singh, Amul; Sharma, Sanjib Kumar

doi:10.4269/ajtmh.20-0035

Cited by 10 publications

(10 citation statements)

References 8 publications

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“…Of the 132 studies included for full-text review, 11 met the inclusion criteria. Authors from a further 29 studies that reported methodology suggesting synchronous 20WBCT and clotting sample collection were contacted, and a further four studies (from three papers) were included [5,30,31]. Thus, 15 studies were included in the systematic review (Fig 1).…”

Section: Resultsmentioning

confidence: 99%

“…Individual patient data (n = 1,865, 82.2%), were either reported, displayed in figures or provided upon request in nine studies [5,16,[30][31][32]34,36,37]. In these studies, the median INR for patients with a false negative 20WBCT (n = 33) was 1.9 (IQR 1.6 to 12.0, skewness of 1.06 and kurtosis of -0.83).…”

Section: A Comparison Of True Positive and False Negative 20wbctmentioning

confidence: 99%

“…Using the individual patient data values described above (n = 1,865), [5,16,[30][31][32]34,36,37] a sub-analysis was performed to assess the ability of the 20WBCT to detect severe coagulopathy, defined as INR >5.0 or fibrinogen <50 mg/dL. The aggregate weighted sensitivity and specificity of the 20WBCT at detecting severe coagulopathy were 0.91 (0.64 to 0.98) and 0.90 (0.74 to 0.96), respectively.…”

Section: Sub-analyses-accuracy Of the 20wbct To Detect Severe Coagulopathymentioning

confidence: 99%

“…Through efforts to include as much available data in the review as possible, the inclusion of five data sets that were not previously fully published renders the conclusions of this review more susceptible to bias. Each of these studies were conducted as part of other published snakebite studies, four of which have undergone peer review (two from one paper) [5,30,31] and the last is pending submission [16]. The effect of snake species and, therefore, mechanism and extent of VICC, varies greatly [20].…”

Section: Limitationsmentioning

confidence: 99%

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The 20-minute whole blood clotting test (20WBCT) for snakebite coagulopathy—A systematic review and meta-analysis of diagnostic test accuracy

et al. 2021

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Background The 20-minute whole blood clotting test (20WBCT) has been used to detect coagulopathy following snakebite for almost 50 years. A systematic review and meta-analysis of the 20WBCT was conducted to evaluate the accuracy of the 20WBCT to detect coagulopathy, indicative of systemic envenoming. Methods and findings Databases were searched from inception up to 09/12/2020 to identify studies that compared the 20WBCT and INR/fibrinogen on five or more subjects. Data was extracted from full-text articles by two reviewers using a predetermined form. Authors of 29 studies that lacked sufficient details in the manuscript were contacted and included if data meeting the inclusion criteria were provided. Included studies were evaluated for bias using a tailored QUADAS-2 checklist. The study protocol was prospectively registered on PROSPERO database (CRD42020168953). The searches identified 3,599 studies, 15 met the inclusion criteria and 12 were included in the meta-analysis. Data was reported from 6 countries and included a total of 2,270 patients. The aggregate weighted sensitivity of the 20WBCT at detecting INR >1.4 was 0.84 (CI 0.61 to 0.94), the specificity was 0.91 (0.76 to 0.97) and the SROC AUC was 0.94 (CI 0.91 to 0.96). The aggregate weighted sensitivity of the 20WBCT at detecting fibrinogen <100 mg/dL was 0.72 (CI 0.58 to 0.83), the specificity was 0.94 (CI 0.88 to 0.98) and the SROC AUC was 0.93 (0.91 to 0.95). Both analyses that used INR and fibrinogen as the reference test displayed considerable heterogeneity. Conclusions In the absence of laboratory clotting assays, the 20WBCT remains a highly specific and fairly sensitive bedside test at detecting coagulopathy following snakebite. However, clinicians should be aware of the importance of operator training, standardized equipment and the lower sensitivity of the 20WBCT at detecting mild coagulopathy and resolution of coagulopathy following antivenom.

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Section: Resultsmentioning

confidence: 99%

Section: A Comparison Of True Positive and False Negative 20wbctmentioning

confidence: 99%

Section: Sub-analyses-accuracy Of the 20wbct To Detect Severe Coagulopathymentioning

confidence: 99%

Section: Limitationsmentioning

confidence: 99%

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The 20-minute whole blood clotting test (20WBCT) for snakebite coagulopathy—A systematic review and meta-analysis of diagnostic test accuracy

et al. 2021

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“…Navin Bhatt et al ,[ 9 ] (2020) published a case series on American Journal of Tropical Medicine and Hygiene, involving 15 cases of viper bite who were treated conservatively without ASV. All the 15 cases had coagulopathy with deranged coagulation parameters (prolonged WBCT), and all of them were discharged within 3-8 days of snake bite after resolution of coagulopathy.…”

Section: Discussionmentioning

confidence: 99%

Prolonged asymptomatic venom induced consumption coagulopathy: Caused by hemotoxic snake bite

Pathania

Rijal

Singh

et al. 2022

Journal of Family Medicine and Primary Care

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A BSTRACT Envenoming and deaths resulting from snake bite are a particularly important public health problem in the tropical world, with the highest burden in rural areas of South East Asia and Africa. Snake bite is one of the most severe “Neglected Tropical Diseases” in the world and more importantly in this part of India. We present a case of hemotoxic snake bite where the coagulation parameters remained deranged for a longer time without any active bleeding manifestations, despite treatment with Anti-Snake Venom (ASV) as per the National Treatment Guidelines. Indian Snake Bite Management Protocol emphasizes on the Role of Whole Blood Clotting Time (WBCT) as a bedside, accessible and feasible test for assessment of coagulopathy even in rural settings. Certain scenarios where the patients present late to our hospital with Snake Bite and Venom Induced Consumption Coagulopathy (VICC), the decision regarding ASV prescription in such patients is quite tricky, and needs to be individualized.

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Prevention and improvement of clinical management of snakebite in Southern Asian countries: A proposed road map

Mukherjee

Mackessy

2021

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Case Report: Management of Pit Viper Envenoming without Antivenom: A Case Series

Cited by 10 publications

References 8 publications

The 20-minute whole blood clotting test (20WBCT) for snakebite coagulopathy—A systematic review and meta-analysis of diagnostic test accuracy

The 20-minute whole blood clotting test (20WBCT) for snakebite coagulopathy—A systematic review and meta-analysis of diagnostic test accuracy

Prolonged asymptomatic venom induced consumption coagulopathy: Caused by hemotoxic snake bite

Prevention and improvement of clinical management of snakebite in Southern Asian countries: A proposed road map

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