Heparin therapy in Russell's viper bite victims with impending dic (a controlled trial)

A controlled clinical trial of low-dose heparin was carried out in confirmed cases of Russell's viper bite. Twenty-eight patients with coagulable blood and serum FDP levels (more than 80 micrograms/ml) were included in the study. They were randomised to receive low-dose heparin in an initial dose of 50 units/kg body weight intravenously immediately after antivenom followed by a continuous infusion of 10 units/kg/hr in isotonic saline for 24 hours, or antivenom alone. Response to treatment was assessed clinically as well as by serial measurements of coagulation factors and biochemical variables. No features of systemic envenoming developed in any patient after treatment, but one patient in each group developed microscopic haematuria. No systemic bleeding or acute renal failure occurred in any patient. Recovery rate from the clotting defect was similar in the two groups, but in patients with initially very low fibrinogen levels there was a tendency for the heparin to restore fibrinogen faster than in comparable patients who did not receive heparin.