Safety of nonsteroidal anti-inflammatory drugs in copperhead snakebite patients

Introduction: Current management guidelines for pit viper envenomations recommend against the use of nonsteroidal anti-inflammatory drugs (NSAIDs) for pain control due to concern for platelet dysfunction and resulting coagulopathy. However, prior research suggests that copperhead snakes generally do not cause coagulopathy and they are responsible for most of the venomous snakebites in the USA. Thus, we compared the occurrences of clinically apparent bleeding and most abnormal laboratory values of coagulation between copperhead envenomation patients who received NSAIDs and those who did not. Methods: We conducted a retrospective chart review of patients who presented to our adult and pediatrics emergency department with copperhead snakebites. We recorded patient demographics, snake type, any NSAIDs given, any opioid analgesics given, any documented bleeding, and most abnormal laboratory values of coagulation. Results: There was no significant difference in most abnormal PTT, fibrinogen, platelet count, and serum creatinine values between copperhead snakebite patients who received NSAIDs and those who did not. Mean INR was lower (p = .011) and hematocrit was higher (p = .018) for NSAID-treated patients than for patients treated without NSAIDs. Three patients demonstrated clinically apparent bleeding; two had epistaxis reported at an outside hospital but received NSAIDs without further bleeding at our hospital. The third had 3 + blood on a urinalysis that was attributed to a urinary tract infection and also received NSAIDs without any other bleeding. Conclusions: There were no bleeding outcomes attributable to NSAID usage among copperhead snakebite patients. The use of NSAIDs in managing pain and inflammation in identified copperhead snakebite patients appears safe.