Is coagulopathy a common consequence of a Vipera berus bite? A retrospective single centre study

Dyląg-Trojanowska, Katarzyna; Hodorowicz-Zaniewska, Diana; Zybaczynska, Justyna; Szczepanik, Antoni M.

doi:10.26444/aaem/75941

Cited by 4 publications

(7 citation statements)

References 10 publications

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“…The most pertinent finding was that the envenomated dogs were hypercoagulable at presentation compared to the healthy control dogs. In contrast to our study, most previous studies using PT, INR and APTT are indicative of hypocoagulability after Vbb envenomation in humans and dogs [4,12,19]. Prolongation of PT and APTT is used in human and veterinary medicine as a reliable indicator of envenomation in cases of suspected snake bite, although normal values do not exclude the possibility of envenomation [28].…”

Section: Discussioncontrasting

confidence: 99%

“…Case reports have described limb and pulmonary thrombosis in humans [6,10] and microthrombi in the renal vasculature of dogs [11] bitten by Vbb. However, persistent bleeding from the snakebite wound, haematomas and ecchymoses have also been reported in dogs and humans bitten by this species of snake [4,12,13].…”

Section: Introductionmentioning

confidence: 98%

“…Since Vbb is the only venomous snake in Scandinavia [2,3], clinical signs of snake envenomation in these countries can be attributed to this species alone. Pain, oedema, nausea, arrhythmia, acute kidney injury and coagulopathy have been reported in humans and dogs [1,[4][5][6][7][8][9], but studies of Vbb envenomation are limited, and the clinical consequences of envenomation by this species are not fully known. Case reports have described limb and pulmonary thrombosis in humans [6,10] and microthrombi in the renal vasculature of dogs [11] bitten by Vbb.…”

Section: Introductionmentioning

confidence: 99%

“…Coagulation analyses may help identify individuals at risk of haemorrhage or thromboembolic disease and thereby contribute to appropriate treatment, but studies reporting such analyses after Vbb envenomation are sparse and contradictory. Studies in humans and dogs have shown thrombocytopenia, prolonged prothrombin time (PT)/international normalized ratio (INR), and prolonged activated partial thromboplastin time (APTT), but hypercoagulability indicated by decreased INR and increased D-dimer concentrations has also been reported during the first 36 hours after Vbb bite [4,12,19]. Longitudinal studies assessing the time course of coagulation disturbances after envenomation by Vbb as well as the effect of antivenom treatment, are lacking.…”

Section: Introductionmentioning

confidence: 99%

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Persistent hypercoagulability in dogs envenomated by the European adder (Vipera berus berus)

et al. 2022

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Background Envenomation by the European adder, Vipera berus berus (Vbb), is a medical emergency. The overall in vivo haemostatic effects of pro- and anticoagulant components in Vbb venom, and the downstream effects of cellular injury and systemic inflammation, are unclear. Objectives To longitudinally describe the global coagulation status of dogs after Vbb envenomation and compare to healthy controls. A secondary aim was to investigate differences between dogs treated with and without antivenom. Methods Citrated plasma was collected at presentation, 12 hours (h), 24 h, 36 h and 15 days after bite from 28 dogs envenomated by Vbb, and from 28 healthy controls at a single timepoint. Thrombin generation (initiated with and without exogenous phospholipids and tissue factor), thrombin-antithrombin (TAT)-complexes and the procoagulant activity of phosphatidylserine (PS)-expressing extracellular vesicles (EVs), expressed as PS-equivalents, were measured. Results At presentation the envenomated dogs were hypercoagulable compared to controls, measured as increased thrombin generation, TAT-complexes and PS-equivalents. The hypercoagulability decreased gradually but compared to controls thrombin generation and PS-equivalents were still increased at day 15. The discrepancy in peak thrombin between envenomated dogs and controls was greater when the measurement was phospholipid-dependent, indicating that PS-positive EVs contribute to hypercoagulability. Lag time was shorter in non-antivenom treated dogs, compared to antivenom treated dogs <24 h after envenomation. Conclusions Hypercoagulability was measured in dogs up to 15 days after Vbb envenomation. Dogs treated with antivenom may be less hypercoagulable than their non-antivenom treated counterparts. Thrombin generation is a promising diagnostic and monitoring tool for Vbb envenomation.

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Section: Discussioncontrasting

confidence: 99%

Section: Introductionmentioning

confidence: 98%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Persistent hypercoagulability in dogs envenomated by the European adder (Vipera berus berus)

et al. 2022

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“…Considering that Europe has a relatively high number of Vipera species with relevant medical aspects, and that Europe shows the most favourable habitat, the underestimation is even greater, confirming the fact that snakebite in Europe is a disease with neglected incidence, morbidity and mortality. This is also justified by the fact that sporadic individual case reports and case series are found in the literature 4–81 …”

Section: Introductionmentioning

confidence: 99%

Vipera snakebite in Europe: a systematic review of a neglected disease

Paolino

Nicola²,

Pontara

et al. 2020

Acad Dermatol Venereol

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In 2009, snakebites were included in the list of the World Health Organization (WHO) neglected diseases. Dermatological literature lacks current and up-to-date articles about snakebites and their management, despite the fact that dermatologists, especially from rural hospitals, can be called into the emergency room to consult the management of suspected snakebites. In this systematic review, we highlighted the main clinical and laboratory aspects of snakebites from Vipera spp. in Europe, by reviewing 3574 studies initially retrieved from PubMed, Embase and Cochrane CENTRAL databases. Of these, 78 were finally included in the systematic review. We found that the most involved taxon was V. berus in 63.3% and the most involved anatomic site of the bite was the upper limbs 53.1% with fang marks reported in 90.5%. The mean age of the patients was 32.9 years, and bites were slightly more common among males (58.2%). A wound washing was performed in 86.9% of cases before the hospitalization. The most frequently reported grade of envenomation was G2 (42.2%). In addition to local dermatological symptoms (extended erythema, oedema, cutaneous necrosis, hives, purpura, petechiae, acute compartment syndrome), numerous systemic symptoms have also been reported, including fatigue (14.4%), pain (75.3%), fever (49.2%), direct anaphylactoid reaction (5.3%), anxiety (60.8%), cranial nerve neurotoxicity (14.8%), dysesthesia/paraesthesia (7.9%), vomiting (33.7%), abdominal pain (23.3%), diarrhoea (15.4%), dyspnoea (6.3%), proteinuria (10.6%) and haematuria (9.3%). Secondary infections were present in 3.5% and disseminated intravascular coagulation in 3.1% of cases, and fasciotomy was performed in 4.2% cases, while an amputation in 6.9%. Only 0.9% of patients died. Antivenom was administered in 3053 cases. In conclusion, there is a pressing need for robust multi-centre randomized control trials, standardized protocol for snakebite management and antivenom administration across Europe and a National snakebite register for each European country.

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