Recurrent hemorrhage after western diamondback rattlesnake envenomation treated with crotalidae polyvalent immune fab (ovine)

Fazelat, Joyia; Teperman, Sheldon; Touger, Michael

doi:10.1080/15563650701753849

Cited by 22 publications

(14 citation statements)

References 10 publications

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“…Th e effi ciency of the antivenom is time-dependent meaning its effi ciency is highest when it is given immediately after the bite or within four hours because the serum blocks the venom and stops it from further devastating the tissue. However, you can give the serum 24 hours after the bite because there is still snake venom in the organism that the antivenom can block [9,22,24,40].…”

Section: Discussionmentioning

confidence: 99%

Venomous snakebites in the Croatian North Dalmatia region

Karlo

Dželalija

Župančić

et al. 2011

Wien Klin Wochenschr

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Section: Discussionmentioning

confidence: 99%

Venomous snakebites in the Croatian North Dalmatia region

Karlo

Dželalija

Župančić

et al. 2011

Wien Klin Wochenschr

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“…Since FabAV replaced antivenom crotalidae polyvalent for treatment of North American crotaline envenomation, many reports of late bleeding have been published, one of which resulted in death. [5][6][7]12 Reports of late bleeding in the published medical literature were recently examined in a systematic review of cohort studies and case series which included more than 1,000 patients with crotaline envenomation. 13 The authors found that only nine patients experienced late bleeding, with only five bleeding events considered medically significant, and none resulting in death or permanent sequelae.…”

Section: Discussionmentioning

confidence: 99%

Bleeding Following Rattlesnake Envenomation in Patients With Preenvenomation Use of Antiplatelet or Anticoagulant Medications

Levine

Ruha

Padilla-Jones

et al. 2014

Academic Emergency Medicine

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Objectives: Rattlesnake envenomations commonly produce coagulopathy and thrombocytopenia, yet clinically significant bleeding is uncommon. It is unknown if patients who use antiplatelet or anticoagulant medications prior to envenomation are at increased risk for bleeding after envenomation.Methods: This was a retrospective cohort study of patients age 14 years and older who were admitted to a single academic medical center for rattlesnake envenomation. Patients who reported use of antiplatelet or anticoagulant medications prior to envenomation were compared to patients not on those medications. Severity and timing of bleeding was compared between groups, as was a composite endpoint of major bleeding at any time, shock, readmission, or death.Results: A total of 319 patients met inclusion criteria; 31 (9.7%) were documented to be taking antiplatelet or anticoagulant medications including aspirin, clopidogrel, and/or warfarin. Seventeen of the 319 patients developed bleeding associated with envenomation (major = 9; minor = 4; trivial = 4), with major bleeding occurring in five patients on antiplatelet or anticoagulant medications versus four patients not on antiplatelet or anticoagulant medications (p < 0.001). Seven of the 17 presented with early bleeding. This early bleeding occurred in three of 31 (9.7%) patients on antiplatelet or anticoagulant medications and four of 288 (1.4%) patients not on antiplatelet or anticoagulant medications (relative risk [RR] = 6.9; 95% confidence interval [CI] = 1.6 to 29.4; p = 0.022). Clinical outcome data were available for 300 of the 319 (94%) subjects following discharge. Late bleeding (bleeding after discharge from the index hospitalization) occurred in nine subjects, one of whom also had early bleeding (major = 2, minor = 3, trivial = 4). Three of these nine subjects with late bleeding were on antiplatelet or anticoagulant medications, compared with six not on antiplatelet or anticoagulant medications (p = 0.042). Both cases of late major bleeding occurred in patients on antiplatelet or anticoagulant medications. Therefore, among patients with follow-up data available, the overall rate of bleeding (early and late) was seven of 28 (25%) in patients taking antiplatelet or anticoagulant medications and 10 of 273 (3.7%) in patients not taking antiplatelet or anticoagulant medications (p < 0.001). The use of antiplatelet or anticoagulant medications was also associated with an increased risk of reaching the composite endpoint of major bleeding, shock, readmission, or death (6 of 31, or 19.4% vs. 14 of 288, or 4.9%; RR = 3.98; 95% CI = 1.65 to 9.62; p = 0.008). Conclusions:The risk of developing bleeding following rattlesnake envenomation is increased in patients who use antiplatelet or anticoagulant medications. This risk is greatest early after envenomation during the index hospitalization. However, risk of late, major bleeding appears also to be greatest in patients on antiplatelet or anticoagulant medications. Extra vigilance should be taken in patients on antiplatele...

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“…In the clinical trial, free venom could be detected by immunoassay at some time following therapy in 2/6 Fab-treated and 0/6 F(ab')2-treated subjects, whereas late thrombocytopenia was observed in 3/6 Fab-treated and 0/6 F(ab')2-treated subjects. However, half-life mismatch does not explain why recurrent episodes of defibrinogenation and thrombocytopenia often fail to fully respond to repeat administration of Fab [33,[35][36][37]. In addition, although unbound Fab fragments have a relatively short half-life, Fab molecules bound to large venom components cannot undergo glomerular filtration.…”

Section: Advantages To Various Drug Designsmentioning

confidence: 89%