Recurrent coagulopathy after antivenom treatment of crotalid snakebite.
BACKGROUND
We studied whether recurrence of coagulopathy, defined as the return of a coagulation abnormality after initial normalization, occurred after the use of antivenin (Crotalidae) polyvalent.


METHODS
A retrospective, blinded, descriptive analysis of 354 consecutive cases of North American crotalid snake envenomation was done. Inclusion criteria were documented clinical evidence of crotalid snakebite, presence of a coagulopathy (platelet count <150,000/mm3, prothrombin time above normal, or fibrinogen level <150 mg/dL), and treatment with antivenin (Crotalidae) polyvalent.


RESULTS
Of 112 cases with a coagulopathy extending beyond 6 hours after envenomation, 31 had sufficient coagulopathy testing to detect recurrence. Fourteen of these patients (45%) had recurrence of coagulopathy, and two cases were severe (fibrinogen level 29 mg/dL; platelet count 36,000/mm3).


CONCLUSIONS
Recurrence of coagulopathy after envenomation by North American crotalid snakes may occur after use of antivenin (Crotalidae) polyvalent and can result in severe coagulation abnormalities.
Bogdan
G M
GM
Rocky Mountain Poison and Drug Center, Denver Health Authority, Colo 80230, USA.
Dart
R C
RC
Falbo
S C
SC
McNally
J
J
Spaite
D
D
D000328:Adult; D000818:Animals; D000997:Antivenins / Q000627:therapeutic use*; D001778:Blood Coagulation Disorders / Q000209:etiology* / Q000628:therapy*; D005260:Female; D006801:Humans; D008297:Male; D012008:Recurrence; D012189:Retrospective Studies; D016037:Single-Blind Method; D012909:Snake Bites / Q000150:complications*; D017819:Viperidae
D000997:Antivenins