Factors Associated With Difficulty Achieving Initial Control With Crotalidae Polyvalent Immune Fab Antivenom in Snakebite Patients

Yin, Shengyan; Kokko, Jamie; Mlynarchek, Sara; Bogdan, Greg; Schaeffer, Tammi H.

doi:10.1111/j.1553-2712.2010.00958.x

Cited by 24 publications

(30 citation statements)

References 21 publications

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“…However, initial control was not achieved after 2 doses, and the patient required repeated doses over a 12-day span, which is among the longest durations of antivenom therapy described. Neurologic deficits and thrombocytopenia prior to administration of antivenom are independently associated with failure to achieve initial control, both of which occurred in this patient [7]. The recurrence phenomenon and unique clinical aspects of this case may have also contributed to the protracted course.…”

Section: Discussionmentioning

confidence: 82%

“…One required 46 vials; however the clinical details of the case are not described [7]. The other describes a 50-year-old man also bitten by a 6-foot Eastern Diamondback rattlesnake requiring 51 total vials of antivenom with the last 6 vials given as continuous intravenous infusion over 36 hours to dissipate the recurrent coagulopathy on day 8.…”

Section: Resultsmentioning

confidence: 99%

“…Failure to achieve initial control (clinical stability, no progression in swelling, and improvement in coagulopathies) after 2 doses of antivenom is considered uncommon by expert clinical consensus [4]. Overall 82.2% of patients achieved initial control in a retrospective study of 247 crotalid envenomations [7] compared to 57% of severely envenomated patients [8].…”

Section: Discussionmentioning

confidence: 99%

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Prolonged Coagulopathy Following Rattlesnake Envenomation Responsive to Antivenom: A Case Report

Roberts¹

2017

Int Arch Clin Pharmacol

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Section: Discussionmentioning

confidence: 82%

Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Prolonged Coagulopathy Following Rattlesnake Envenomation Responsive to Antivenom: A Case Report

Roberts¹

2017

Int Arch Clin Pharmacol

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“…11,12 The safety of FabAV was subsequently established, and observational studies demonstrated that FabAV administration is associated with cessation of progression of tissue injury in copperhead victims. 8,13,14 Whether this leads to improved recovery of limb function is unstudied, and the role of FabAV in the management of patients with nonlife-threatening envenomation is controversial. Although many experts recommend treating all crotaline envenomation patients according to clinical presentation, irrespective of species, others recommend withholding FabAV from copperhead victims.…”

Section: How This Is Relevant To Clinical Practicementioning

confidence: 99%

“…[3][4][5] More than 95% of copperhead victims develop significant pain and swelling of the envenomated limb, but systemic venom effects are uncommon and death is rare. [6][7][8][9] Current data support only a crude understanding of the time course of recovery from limb injury with or without antivenom therapy. Although most patients …”

Section: Introduction Backgroundmentioning

confidence: 99%

The Efficacy of Crotalidae Polyvalent Immune Fab (Ovine) Antivenom Versus Placebo Plus Optional Rescue Therapy on Recovery From Copperhead Snake Envenomation: A Randomized, Double-Blind, Placebo-Controlled, Clinical Trial

Gerardo

Quackenbush

Lewis

et al. 2017

Annals of Emergency Medicine

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Does This Patient Have a Severe Snake Envenomation?

et al. 2019

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IMPORTANCE Venomous snakebite severity ranges from an asymptomatic dry bite to severe envenomation and death. The clinical evaluation aids in prognosis and is essential to determine the risks and potential benefits of antivenom treatment.OBJECTIVES To identify historical features, clinical examination findings, basic laboratory testing, and clinical grading scales that will risk-stratify patients with pit viper snake envenomation for severe systemic envenomation, severe tissue injury, and/or severe hematologic venom effects.DATA SOURCES We conducted a structured search of PubMed (1966-October 3, 2017 and Embase database (1980( -October 3, 2017 to identify English-language studies that evaluated clinical features predictive of severe envenomation. STUDY SELECTIONWe included studies that evaluated the test performance of at least 1 clinical finding with an acceptable reference standard of severe envenomation for venomous snakes of the Western Hemisphere. Only studies involving the most common subfamily, Crotalinae (pit vipers), were evaluated. Seventeen studies with data were available for abstraction. DATA EXTRACTION AND SYNTHESISThe clinical features assessed and severity outcome measures were extracted from each original study. We assessed severity in 3 categories: systemic toxicity, tissue injury, and hematologic effects. Differences were resolved by author consensus. RESULTSThe pooled prevalence of severe systemic envenomation was 14% (95% CI, 9%-21%). The pooled prevalence of severe tissue injury and severe hematologic venom effects were 14% (95% CI, 12%-16%) and 18% (95% CI, 8%-27%), respectively. Factors increasing the likelihood of severe systemic envenomation included the time from bite to care of 6 or more hours (likelihood ratio [LR], 3.4 [95% CI, 1.1-6.4]), a patient younger than 12 years (LRs, 3.2 [95% CI, 1.5-7.1] and 2.9 [95% CI, 1.3-6.2]), large snake size (LR, 3.1 [95% CI, 1.5-5.7]), and ptosis (LRs, 1.4 [95% CI, 1.0-2.1] and 3.8 [95% CI, 1.8-8.3]). Envenomation by the genus Agkistrodon (copperhead and cottonmouth), as opposed to rattlesnakes, decreased the likelihood of severe systemic envenomation (LR, 0.28 [95% CI, 0.10-0.78]). Initial hypofibrinogenemia (LR, 5.1 [95% CI, 1.7-15.0]) and thrombocytopenia (LR, 3.7 [95% CI, 1.9-7.3]) increased the likelihood of severe hematologic venom effects. Other clinical features from history, physical examination, or normal laboratory values were not discriminative.CONCLUSIONS Clinical features can identify patients at increased risk of severe systemic envenomation and severe hematologic venom effects, but there are few features that are associated with severe tissue injury or can confidently exclude severe envenomation. Physicians should monitor patients closely and be wary of progression from nonsevere to a severe envenomation and have a low threshold to escalate therapy as needed.

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Factors Associated With Difficulty Achieving Initial Control With Crotalidae Polyvalent Immune Fab Antivenom in Snakebite Patients

Abstract: Background: The prescribing information for Crotalidae Fab antivenom (FabAV) instructs clinicians to administer FabAV until initial control of the envenomation syndrome is achieved. Risk factors for difficulty achieving initial control are not known.

Cited by 24 publications

References 21 publications

Prolonged Coagulopathy Following Rattlesnake Envenomation Responsive to Antivenom: A Case Report

Prolonged Coagulopathy Following Rattlesnake Envenomation Responsive to Antivenom: A Case Report

The Efficacy of Crotalidae Polyvalent Immune Fab (Ovine) Antivenom Versus Placebo Plus Optional Rescue Therapy on Recovery From Copperhead Snake Envenomation: A Randomized, Double-Blind, Placebo-Controlled, Clinical Trial

Does This Patient Have a Severe Snake Envenomation?

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