Role of thromboelastography in the management of snake bite: A case report from India

Nag, Ipsita; Datta, Suvro Sankha; De, Dibyendu; Pal, Partha; Das, Sutapa

doi:10.1016/j.transci.2016.10.003

Cited by 15 publications

(18 citation statements)

References 5 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…This lack of baseline data is a major barrier to studying thromboelastography for this application. There have been case reports or small case series of thromboelastography in rattlesnake envenomation but many have been from outside of North America [12][13][14][15] and details about methodology were not always included (e.g., citrated versus whole blood, which activator used, etc.). Moreover, all studies, whether from North America [16][17][18] or not, have reported only standard thromboelastography, which do not include platelet activation studies.…”

Section: Introductionmentioning

confidence: 99%

Thromboelastography with Platelet Studies (TEG® with PlateletMapping®) After Rattlesnake Envenomation in the Southwestern United States Demonstrates Inhibition of ADP-Induced Platelet Activation As Well As Clot Lysis

Kang

Fisher

2019

J. Med. Toxicol.

View full text Add to dashboard Cite

Introduction Hematologic effects of North American rattlesnake envenomation can include fibrinogenolysis and thrombocytopenia, depending on species, geography, and other variables. During treatment, these effects are routinely monitored through assessment of fibrinogen concentrations and platelet counts. However, these tests provide no information about fibrinolysis or platelet dysfunction, both of which can also occur with venom from some species. Methods This was a retrospective chart review of patients admitted to a quaternary care academic hospital (Banner -University Medical Center Phoenix) in the southwestern United States for treatment of rattlesnake envenomation, over an approximately 1year period from March 2017 through April 2018. Patients who had thromboelastography with platelet studies (TEG® with PlateletMapping®) during their care were included. Results Twelve patients were identified for this study. Four patients exhibited inhibition of ADP-induced platelet activation: one had normal fibrinogen and platelet count, two had concurrent hypofibrinogenemia, and one had concurrent thrombocytopenia. Crotalidae polyvalent immune Fab (ovine) reversed platelet inhibition in the single patient for whom serial thromboelastographs were available. Fibrinolysis was present in seven patients and resolved in the two patients with serial thromboelastographs. Conclusions Inhibition of ADP-induced platelet aggregation and fibrinolysis occurred independent of hypofibrinogenemia and thrombocytopenia, indicating fibrinogen concentration (or protime) and platelet count monitoring alone is insufficient to assess the extent of hematologic toxicity in rattlesnake envenomation. Crotalidae polyvalent immune Fab (ovine) reversed platelet inhibition in one case, suggesting platelet inhibition could also be used in treatment decisions. Fibrinolysis could also be reversed, although the timing to antivenom administration was less clear.

show abstract

Section: Introductionmentioning

confidence: 99%

Thromboelastography with Platelet Studies (TEG® with PlateletMapping®) After Rattlesnake Envenomation in the Southwestern United States Demonstrates Inhibition of ADP-Induced Platelet Activation As Well As Clot Lysis

Kang

Fisher

2019

J. Med. Toxicol.

View full text Add to dashboard Cite

show abstract

“…TEG showed a difference in data tracings. 9 Additional case reports have reported using ROTEM or TEG in the assessment and management of North American pit viper envenomation, 10,11 probable Echis envenomation in Afghanistan, 12 viper envenomation in India, 13 snake envenoming with coagulopathy in Djibouti, 14 and coagulopathy associated with Viperidae envenoming in Vietnam. 15 The largest series using TEG is from South Africa, where 51 cases were reviewed.…”

Section: Discussionmentioning

confidence: 99%

Case Report: Rotational Thromboelastometry in Taipan Envenomation

Tacon

Munas

Little

2022

The American Journal of Tropical Medicine and Hygiene

View full text Add to dashboard Cite

Venom-induced consumption coagulopathy (VICC) is one of the most dangerous syndromes caused by snake envenomation and can be caused by several snake species worldwide, including the Australian coastal taipan. Rotational thromboelastometry (ROTEM) provides real-time point-of-care information on all stages of clot formation; however, it has yet to be formally evaluated in the assessment of VICC. We report three cases of Taipan envenomation causing VICC and the associated ROTEM results. The implications for future use of ROTEM in the assessment, management, and further research of VICC are discussed.

show abstract

“…To the best of our knowledge, this combination has not previously been reported. TEG showed that the coagulation curve was close to normal after addition of FBG preparation[ 8 ]. Given that our patient’s coagulation factors and platelet counts were normal, we believe that he had the type of coagulation dysfunction that is mediated via the above-mentioned SVSPs pathway.…”

Section: Discussionmentioning

confidence: 99%

Persistent fibrinogen deficiency after snake bite: A case report

Xu¹,

Li²,

Han³

et al. 2021

WJCC

View full text Add to dashboard Cite

BACKGROUND Venom-induced consumption coagulopathy (VICC) is characterized by coagulation dysfunction accompanied by decreased coagulation factor activity and fibrinogen (FBG) concentrations. We report a patient with VICC caused by snake bite who manifested persistent FBG deficiency without abnormal coagulation factor activity. This information may be helpful in diagnosing and treating VICC. CASE SUMMARY A 49-year-old man who had been bitten by a snake 13 h previously was admitted to the Emergency Department of our hospital with visible swelling of a finger and a bleeding puncture site. The provisional diagnosis was VICC, this being made based on persistent bleeding from the puncture site and subcutaneous hemorrhage. Laboratory evidence of coagulation abnormalities, including fibrinolysis, and findings on thromboelastography confirmed VICC. He had persistent afibrinogenemia requiring intravenous infusions of cryoprecipitate and fresh frozen plasma, together with continuous large doses of human FBG. After this treatment, the patient’s right upper limb swelling improved significantly and his subcutaneous hemorrhage resolved. All of his abnormal laboratory findings returned to normal by day 25. During 6 months’ of follow-up, the patient had no further hemorrhagic events. CONCLUSION Hemorrhagic snake venom can result in coagulation dysfunction characterized by persistent FBG deficiency without abnormal coagulation factor activity.

show abstract

Role of thromboelastography in the management of snake bite: A case report from India

Cited by 15 publications

References 5 publications

Thromboelastography with Platelet Studies (TEG® with PlateletMapping®) After Rattlesnake Envenomation in the Southwestern United States Demonstrates Inhibition of ADP-Induced Platelet Activation As Well As Clot Lysis

Thromboelastography with Platelet Studies (TEG® with PlateletMapping®) After Rattlesnake Envenomation in the Southwestern United States Demonstrates Inhibition of ADP-Induced Platelet Activation As Well As Clot Lysis

Case Report: Rotational Thromboelastometry in Taipan Envenomation

Persistent fibrinogen deficiency after snake bite: A case report

Contact Info

Product

Resources

About