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Risk of stroke with antivenom usage after venomous snakebite in Taiwan: a population-based cohort study
1Division of Chest Medicine, Department of Internal Medicine, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan.
Insights
Venomous snakebites increase the risk of hemorrhagic stroke, particularly after antivenom treatment. This finding highlights a critical complication of snakebite envenomation requiring further investigation.
Area of Science:
- Neurology
- Toxicology
- Epidemiology
Background:
- Stroke is a rare but severe complication of venomous snakebites.
- Understanding the link between snakebite and stroke risk is crucial for patient management.
Purpose of the Study:
- To investigate the association between venomous snakebite and the risk of acute stroke.
- To identify specific stroke types linked to snakebite envenomation.
Main Methods:
- Retrospective cohort study using Taiwan National Health Insurance Research Database (2000-2012).
- Propensity score matching compared 535 venomous snakebite patients with 2140 controls.
- Competing risk model analyzed stroke incidence, adjusting for risk factors.
Main Results:
- Venomous snakebite was associated with a 2.68-fold increased risk of hemorrhagic stroke.
- Patients receiving antivenom post-snakebite showed a 2.72-fold higher risk of hemorrhagic stroke.
- Older individuals (>65 years) faced a greater risk of hemorrhagic stroke following snakebite.
Conclusions:
- Venomous snakebite, especially with antivenom use, is linked to a significantly increased risk of hemorrhagic stroke.
- The underlying mechanisms warrant further research to improve clinical outcomes.
Background And Purpose:
Stroke is a rare complication of snakebites, but may lead to serious sequelae. We aimed to explore the relationship between venomous snakebite and the risk for acute stroke, in a nationwide population-based cohort study.
Methods:
This retrospective cohort study used claims data between 1 January 2000 and 31 December 2012, from the Taiwan National Health Insurance Research Database. The study included data of patients aged 18 years or older with venomous snakebite (n = 535), matched for propensity score with controls without venomous snakebite (n = 2140). The follow-up period was the duration from the initial diagnosis of venomous snakebite and administration of antivenom to the date of an acute stroke, or until 31 December 2013. The competing risk model was used to estimate the hazard ratio (HR) and 95% confidence intervals (CIs) of stroke, ischemic stroke and hemorrhagic stroke, after adjusting for demographic and other possible stroke risk factors.
Results:
The adjusted HR for the venomous snakebite group compared with the control group was 2.68 for hemorrhagic stroke (95% CI = 1.35-5.33). Stratified analysis showed that the older age group (>65 years old) had a higher risk of hemorrhagic stroke. A 2.72-fold significant increase in the risk for hemorrhagic stroke was observed following venomous snakebite with antivenom usage (95% CI = 1.41-5.26).
Conclusion:
Venomous snakebite is associated with an increased risk of hemorrhagic stroke after the use of antivenom. Further study of the underlying mechanism is warranted.
