Hemostatic Analysis of Simulated Gloydius ussuriensis Envenomation Using Canine Blood: A Comparison of Thromboelastography and Classical Coagulation Tests

Abstract

Snake envenomation may lead to venom-induced consumptive coagulopathy (VICC), usually diagnosed by classical coagulation tests (CCTs), such as prothrombin time (PT) and activated partial thromboplastin time (aPTT). However, the results of CCTs are frequently normal in the initial stages, which may delay anti-venom treatments. Thromboelastography (TEG) is a point-of-care and real-time diagnostic tool that enables a comprehensive assessment of the coagulation process. This in vitro study aimed to determine concentration-dependent changes in canine blood caused by Gloydius ussuriensis (G. ussuriensis) envenomation using TEG and CCTs. Lyophilized G. ussuriensis venom was reconstructed using mouse intravenous lethal dose 50 (LD50iv) and serially diluted to 25% LD50iv, 50% LD50iv, and 75% LD50iv to reproduce VICC at different concentrations. Normal saline was used for the control. We compared TEG values of the reaction time (R), kinetic time (K), rate of clot formation (α-angle), maximum amplitude (MA), fibrinolysis at 30 min (LY30), and global strength of the clot (G) with those of PT, aPTT, fibrinogen, and platelet counts (PLTs). Most TEG parameters, except R and LY30, demonstrated statistically significant changes compared with the control at all concentrations. CCTs, except PLTs, revealed significant changes at ≥50% LD50iv. Thus, TEG could be a useful diagnostic strategy for early VICC and preventing treatment delay.

Children and Snakebite: Snake Venom Effects on Adult and Paediatric Plasma

“…In this way we controlled for the venom concentration, the age of patients, and time since envenomation. While valuable for different purposes, testing plasma from envenomed patients leads to insensitivity to classic coagulation tests [ 38 , 40 ].…”

Thromboelastographic evaluation in dogs with Asian pit viper (<i>Gloydius</i>) envenomation

“…Snake envenomation is a frequent medical emergency in many countries [ 1 , 11 ]. It is estimated that 2 million people are bitten by venomous snakes annually, leading to 100,000 fatalities [ 9 , 17 ]. On average, 3,000 people are affected by snake envenomation annually in South Korea, resulting in 5 casualties [ 8 , 17 ].…”

“…In South Korea, VICC occurs in around 25% of human victims after Gloydius and Rhabdophis envenomation, but clinical information regarding VICC in veterinary medicine is limited [ 10 ]. Abnormal laboratory findings related to VICC include thrombocytopenia, prolonged prothrombin time (PT), activated partial thromboplastin time (aPTT), low fibrinogen, and elevated D-dimer levels [ 8 , 9 ]. These coagulation tests, such as PT and aPTT, are widely used, they have significant limitations.…”

“…TEG is a viscoelastic diagnostic tool widely used in veterinary medicine to evaluate global hemostasis from clot formation to fibrinolysis [ 1 , 9 , 11 , 14 ]. TEG is a clinically useful diagnostic tool for assessing snouted cobra and crotalid snake envenomation [ 1 , 11 ].…”

“…Asian pit viper ( Gloydius ) envenomation is characterized by various clinical signs, including nausea, dizziness, hypotension, and coagulopathy [ 10 ]. The most concerning aspect is coagulopathy associated with significant hemorrhage, specifically characterized by VICC [ 9 , 12 ]. Coagulopathy induced by Asian pit viper ( Gloydius ) envenomation is caused by venom components, including salmosin, brevinase, halyxin, halysase, salmorin in Gloydius brevicaudus venom, calobin in Gloydus ussuriensis venom, and saxatilin in Gloydius intermedius venom [ 16 ].…”