Failure of antivenom to improve recovery in Australian snakebite coagulopathy.
BACKGROUND
Venom-induced consumption coagulopathy (VICC) is an important feature of snake envenoming.


OBJECTIVE
To investigate the effect of antivenom and fresh frozen plasma (FFP) on recovery of VICC in Australian elapid snake envenoming.


METHODS
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.


CONCLUSIONS
Antivenom did not appear to be effective for the coagulopathy in snake envenoming in Australia. FFP appeared to shorten the time of VICC recovery.
Isbister
G K
GK
Tropical Toxinology Unit, Menzies School of Health Research, Charles Darwin University, Darwin, Australia. geoffrey.isbister@menzies.edu.au
Duffull
S B
SB
Brown
S G A
SG
D000328:Adult; D000367:Age Factors; D000997:Antivenins / Q000008:administration & dosage*; D001315:Australia; D001777:Blood Coagulation / Q000187:drug effects; D004211:Disseminated Intravascular Coagulation / Q000097:blood / Q000209:etiology / Q000628:therapy*; D004305:Dose-Response Relationship, Drug; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010949:Plasma; D011446:Prospective Studies; D012737:Sex Factors; D012909:Snake Bites / Q000150:complications*; D016896:Treatment Outcome
D000997:Antivenins