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Heparin therapy in Russell's viper bite victims with impending dic (a controlled trial)
Myint-Lwin1, Tin-Nu-Swe, Myint-Aye-Mu
1Clinical Research Unit for Snake Bite, Rangoon, Burma.
Summary
Low-dose heparin did not significantly alter recovery from Russell's viper bite coagulopathy. However, heparin showed a trend towards faster fibrinogen restoration in patients with severe hypofibrinogenemia.
Area of Science:
- Toxicology
- Hematology
- Clinical Medicine
Background:
- Russell's viper envenomation is a significant cause of coagulopathy.
- Antivenom therapy is the mainstay treatment, but coagulopathy may persist.
- The role of adjunctive therapies like heparin in managing viper bite coagulopathy requires further investigation.
Purpose of the Study:
- To evaluate the efficacy of low-dose heparin as an adjunctive treatment in Russell's viper bite coagulopathy.
- To assess the impact of heparin on coagulation factor restoration and clinical outcomes.
- To determine the safety profile of low-dose heparin in this context.
Main Methods:
- A randomized controlled trial was conducted involving 28 patients with confirmed Russell's viper bites and coagulable blood.
- Patients received either low-dose heparin (50 units/kg IV followed by 10 units/kg/hr infusion for 24 hours) plus antivenom, or antivenom alone.
- Treatment response was monitored through clinical assessment and serial measurements of coagulation factors and biochemical variables.
Main Results:
- No systemic envenoming symptoms developed post-treatment in either group.
- Microscopic haematuria occurred in one patient in each treatment arm.
- No instances of systemic bleeding or acute renal failure were observed.
- The overall recovery rate of clotting defects was comparable between the heparin and control groups.
- A trend towards faster fibrinogen level restoration was noted in patients receiving heparin, particularly those with initially very low fibrinogen.
Conclusions:
- Low-dose heparin, when added to antivenom, did not significantly improve the overall recovery rate from Russell's viper bite-induced coagulopathy.
- Heparin may offer a potential benefit in accelerating fibrinogen restoration in patients with severe hypofibrinogenemia.
- Low-dose heparin appears to be safe for use in Russell's viper bite patients, with no increased risk of major bleeding or renal complications.
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