Current Treatment for Venom-Induced Consumption Coagulopathy Resulting from Snakebite

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.

Severe coagulopathy and transient hypertension following a Rhabdophis subminiatus bite: a case report

“…The diagnostic criteria for DIC with enhanced fi brinolysis includes an elevated thrombinantithrombin complex (≥20µg/L), a plasmin-α 2 complex ≥10µg/L, a fi brin degradation product (FDP) level ≥80µg/L, a fi brinogen level <100mg/dL, and an increased FDP/D-dimer ratio (5) . Other useful hemostatic tests include a 20-minute whole blood clotting test, a PT test, an aPTT test, and an INR test (6) . The main treatment for coagulopathy due to venom is antivenom administration; however, allergic reactions, high cost, and unavailability often limit its use (2) .…”

Hemocoagulase might not control but worsen gastrointestinal bleeding in an elderly patient with type II respiratory failure

“…However, the potential adverse events related to hemocoagulase are poorly recognized. Venom-induced consumption coagulopathy is one of the commonest types of coagulopathy, which results from snakebite and occurs in envenoming due to several snakes, so that caution should be warranted in using such products obtained by snake venom procoagulant toxins (22).…”

A Study of Cardiac Profile in Patients with Snake Envenomation and Its Complications

“…Mechanism of cardiotoxicity includes direct toxic effect on the myocardium, coagulation abnormalities and vasopasm induced by hemorrhagins or endothelins contained in the venom of some snakes [9]. Causes of hypotension and shock include hypovolemia, vasodilatation, and myocardial dysfunction.…”