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Risk factor, monitoring, and treatment for snakebite induced coagulopathy: a multicenter retrospective study

Yong Jun Jeon1, Jong Wan Kim2, SungGil Park2

  • 1Department of Surgery, Chinjujeil Hospital, Jinju, Korea.

Acute and Critical Care
|November 20, 2019
PubMed

Insights

Lower cholesterol levels may indicate a higher risk of disseminated intravascular coagulation (DIC) after snakebite. Coagulopathy monitoring is essential for 4-5 days post-bite, as standard treatments may not benefit patients without bleeding.

Area of Science:

  • Toxicology
  • Hematology
  • Clinical Medicine

Background:

  • Snakebite envenomation can lead to coagulopathy, a complication distinct from disseminated intravascular coagulation (DIC) from other causes.
  • The optimal treatment for snakebite-associated coagulopathy remains a subject of debate.

Purpose of the Study:

  • To investigate the clinical features and outcomes of snakebite-associated coagulopathy.
  • To identify risk factors for overt DIC following snakebite.
  • To evaluate the effectiveness of current treatment strategies.

Main Methods:

  • Retrospective review of medical records for patients hospitalized due to snakebite between January 2006 and September 2018.
  • Analysis of patient demographics, clinical presentations, laboratory results, and treatment interventions.
  • Application of the International Society of Thrombosis and Hemostasis scoring system to diagnose overt DIC.

Main Results:

  • Of 226 hospitalized patients, 21 developed overt DIC. Initial low cholesterol levels were associated with overt DIC development.
  • Prolonged International Normalized Ratio (INR) was observed up to 4-5 days post-bite.
  • High-dose antivenom and blood product transfusions (fresh frozen plasma, cryoprecipitate) did not shorten INR duration or hospital stay in non-bleeding DIC patients.

Conclusions:

  • Low initial cholesterol may be a risk factor for overt DIC post-snakebite.
  • Continuous coagulopathy assessment for at least 4-5 days is crucial, even in asymptomatic patients.
  • Aggressive antivenom and transfusion strategies may not be beneficial for coagulopathic patients without active bleeding.
Abstract

Keywords:
antivenomblood transfusionconsumption coagulopathiesdisseminated intravascular coagulopathysnakebite

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