The role for coagulation markers in mild snakebite envenomations.

Area of Science:

• Emergency Medicine
• Toxicology
• Clinical Pathology

Background:

• Most snakebite patients do not have severe envenomation.
• Guidelines for coagulation marker testing in mild/moderate envenomation are lacking.
• Current practices may not effectively identify all patients needing coagulation assessment.

Purpose of the Study:

• To determine if coagulation studies can be limited to severe envenomation or rattlesnake bites.
• To evaluate the utility of current criteria for ordering coagulation markers in snakebite patients.

Main Methods:

• Retrospective chart review of 131 crotalid snakebite cases over 8 years.
• Data abstracted included patient demographics, snake type, envenomation severity, coagulation results, antivenom use, and admission status.
• Analysis focused on identifying patients with abnormal coagulation markers.

Main Results:

• 35% of patients (26.7%) presented with coagulation marker abnormalities.
• Excluding patients with mild/moderate envenomation would miss 89% of abnormal coagulation markers.
• Excluding non-rattlesnake envenomations would miss 77% of abnormal coagulation markers.

Conclusions:

• No low-risk subset of snakebite patients was identified for whom coagulation testing could be omitted.
• Routine coagulation marker testing is suggested for all ED patients with copperhead, moccasin, or rattlesnake envenomation.
• Further prospective studies are needed to refine indications for coagulation marker testing.