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Related Experiment Videos

Clinically applicable laboratory end-points for treating snakebite coagulopathy.

Geoffrey K Isbister1, Vaughan Williams, Simon G A Brown

  • 1Tropical Toxinology Unit, Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, Australia. geoffrey.isbister@menzies.edu.au

Pathology
|March 31, 2007
PubMed
Summary
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Prothrombin time (PT) and activated partial thromboplastin time (aPTT) effectively monitor recovery from snakebite coagulopathy. Fibrinogen levels are less reliable indicators for managing venom-induced consumptive coagulopathy (VICC).

Area of Science:

  • Toxicology
  • Hematology
  • Clinical Medicine

Background:

  • Snakebite envenoming can cause consumptive coagulopathy, a life-threatening condition.
  • Accurate monitoring of clotting function is crucial for effective treatment of venom-induced consumptive coagulopathy (VICC).

Purpose of the Study:

  • To identify the most reliable coagulation tests for assessing recovery from VICC after snakebite.
  • To compare the utility of fibrinogen, prothrombin time (PT), and activated partial thromboplastin time (aPTT) in VICC management.

Main Methods:

  • Prospective recruitment of snakebite cases to the Australian Snakebite Project.
  • Serial monitoring of clottable fibrinogen, PT, and aPTT in patients with VICC treated with antivenom.
  • Analysis of time to recovery for PT (<24 seconds), aPTT, and detectable fibrinogen post-antivenom administration.

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Main Results:

  • Recovery times varied: PT <24 seconds (median 9.2 hours), measurable aPTT (median 5.2 hours), and detectable fibrinogen (median 8.8 hours).
  • Fibrinogen was detected earlier than PT recovery in 10 cases, but standard assays offered limited additional clinical value.
  • Highly sensitive fibrinogen assays detected fibrinogen before other markers in only 7% of patients.

Conclusions:

  • Prothrombin time (PT) and activated partial thromboplastin time (aPTT) are effective, accessible, and cost-efficient markers for VICC treatment.
  • Clotting function recovery may take longer than previously assumed after venom neutralization.
  • Routine fibrinogen assays do not significantly enhance the management of VICC compared to PT and aPTT.