Bedside Coagulation Tests in Diagnosing Venom-Induced Consumption Coagulopathy in Snakebite

Area of Science:

• * Toxicology
• * Hematology
• * Clinical Diagnostics

Background:

• * Venom-induced consumption coagulopathy is a critical systemic effect of snake envenoming.
• * Accurate diagnosis of coagulopathy guides timely antivenom administration, the primary treatment.
• * Bedside coagulation tests are vital for diagnosing coagulopathy in resource-limited settings where most snakebites occur.

Purpose of the Study:

• * To review and analyze clinical studies on bedside coagulation tests used in snakebite patients.
• * To identify commonly used bedside clotting assays and evaluate their validation and application.

Main Methods:

• * A literature search was conducted in MEDLINE® from 1946 to November 30, 2019.
• * 147 articles describing bedside clotting assays for snakebite patients were included in the review.
• * Identified tests included the Lee-White clotting test, 20-minute whole blood clotting time, and venous clotting time.

Main Results:

• * The 20-minute whole blood clotting time is the most frequently used test globally for diverse snake species.
• * Venous clotting time is primarily used in Thailand; a validated Lee-White test is used in South America.
• * Many validation studies suffer from methodological limitations, including small sample sizes and inadequate case authentication.

Conclusions:

• * Existing bedside coagulation tests, particularly the 20-minute whole blood clotting time, require methodological improvements and further validation.
• * There is a need for developing new, cost-effective, reliable, and rapid bedside coagulation tests for snakebite management.
• * Standardization of observation times and validation methodologies is crucial for accurate diagnosis and treatment.