QJM Advance Access originally published online on July 1, 2009
QJM 2009 102(8):563-568; doi:10.1093/qjmed/hcp081
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Failure of antivenom to improve recovery in Australian snakebite coagulopathy
From the 1Tropical Toxinology Unit, Menzies School of Health Research, Charles Darwin University, Darwin,2Department of Clinical Toxicology and Pharmacology, Calvary Mater Hospital, Newcastle, New South Wales, Australia,3School of Pharmacy, University of Otago, Dunedin, New Zealand,4Centre for Clinical Research in Emergency Medicine, Western Australian Institute for Medical Research and The University of Western Australia Centre for Medical Research and 5Discipline of Emergency Medicine, University of Western Australia, Royal Perth Hospital, Perth, Australia
Address correspondence to G.K. Isbister, Calvary Mater Newcastle Hospital, Edith St, Waratah NSW 2298, Australia. email: geoffrey.isbister{at}menzies.edu.au
Received 24 November 2008 and in revised form 4 June 2009
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Abstract |
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Background: Venom-induced consumption coagulopathy (VICC) is an important feature of snake envenoming.
Aim: To investigate the effect of antivenom and fresh frozen plasma (FFP) on recovery of VICC in Australian elapid snake envenoming.
Design: Prospective cohort study.
Methods: Patients with VICC were included from the Australian Snakebite Project (ASP). Time to recovery of VICC (defined as time until INR <2) was investigated using a time to event analysis in WinBUGS. The model considered the effects of age, sex, snake type, time of antivenom after bite, antivenom dose and use of FFP within 4 h.
Results: The study included 167 cases of VICC, median age being 41 [interquartile range (IQR): 28–53) years, and 130 (78%) were males. Antivenom was administered at a median of 3.6 (IQR: 2.2–5.6) h after the bite at a median dose of four vials (IQR: 2–6 vials). Thirteen patients received FFP within 4 h. Recovery of VICC occurred after a median of 14.4 (IQR: 11.5–17.5) h, and only the use of FFP within 4 h influenced the time to recovery. Neither antivenom dose nor time of antivenom administration had an effect on recovery of VICC. In patients administered with FFP, 12% [credible interval (CrI): 6–21%] and 81% (CrI: 61–94%) had recovered at 6 and 12 h, respectively, vs 2.5% (CrI: 1.5–4%) and 28% (CrI: 22–34%) not receiving FFP.
Discussion: Antivenom did not appear to be effective for the coagulopathy in snake envenoming in Australia. FFP appeared to shorten the time of VICC recovery.