title: Detection of venom after antivenom is not associated with persistent coagulopathy in a prospective cohort of Russell's viper (Daboia russelii) envenomings.
abstract: BACKGROUND
  Venom recurrence or persistence in the circulation after antivenom treatment has been documented many times in viper envenoming. However, it has not been associated with clinical recurrence for many snakes, including Russell's viper (Daboia spp.). We compare the recovery of coagulopathy to the recurrence or persistence of venom in patients with Russell's viper envenoming.
  
  
  RESULTS
  The study included patients with Russell's viper (D. russelii) envenoming presenting over a 30 month period who had Russell's viper venom detected by enzyme immunoassay. Demographics, information on the snake bite, and clinical effects were collected for all patients. All patients had serum collected for venom specific enzyme immunoassay and citrate plasma to measure fibrinogen levels and prothrombin time (international normalised ratio; INR). Patients with venom recurrence/persistence were compared to those with no detectable recurrence of venom. There were 55 patients with confirmed Russell's viper envenoming and coagulopathy with low fibrinogen concentrations: 31 with venom recurrence/persistence, and 24 with no venom detected post-antivenom. Fibrinogen concentrations increased and INR decreased after antivenom in both the recurrence and non-recurrence patients. Clinical features, laboratory parameters, antivenom dose and length of hospital were similar for both groups. Pre-antivenom venom concentrations were higher in patients with venom recurrence/persistence with a median venom concentration of 385 ng/mL (16-1521 ng/mL) compared to 128 ng/mL (14-1492 ng/mL; p = 0.008).
  
  
  CONCLUSIONS
  Recurrence of Russell's viper venom was not associated with a recurrence of coagulopathy and length of hospital stay. Further work is required to determine if the detection of venom recurrence is due to the venom specific enzyme immunoassay detecting both venom-antivenom complexes as well as free venom.
authors.affiliation: School of Medicine and Public Health, University of Newcastle, Callaghan, New South Wales, Australia; Faculty of Medicine, University of Peradeniya, Peradeniya, Sri Lanka.
authors.forename: Kalana
authors.initials: K
authors.lastname: Maduwage
authors.affiliation: Department of Clinical Toxicology and Pharmacology, Calvary Mater Newcastle, Newcastle, New South Wales, Australia.
authors.forename: Margaret A
authors.initials: MA
authors.lastname: O'Leary
authors.affiliation: Hunter Haematology Research Group, Calvary Mater Newcastle, Newcastle, New South Wales, Australia.
authors.forename: Fiona E
authors.initials: FE
authors.lastname: Scorgie
authors.affiliation: South Asian Clinical Toxicology Research Collaboration (SACTRC), Faculty of Medicine, University of Peradeniya, Peradeniya, Sri Lanka.
authors.forename: Seyed
authors.initials: S
authors.lastname: Shahmy
authors.affiliation: South Asian Clinical Toxicology Research Collaboration (SACTRC), Faculty of Medicine, University of Peradeniya, Peradeniya, Sri Lanka; Clinical Pharmacology and Toxicology Group, Professorial Medicine Unit, The Prince of Wales Clinical School, University of New South Wales, Sydney, New South Wales, Australia.
authors.forename: Fahim
authors.initials: F
authors.lastname: Mohamed
authors.affiliation: District Hospital Hingurakgoda, Hingurakgoda, Sri Lanka.
authors.forename: Chandana
authors.initials: C
authors.lastname: Abeysinghe
authors.affiliation: General Hospital Matara, Matar, Sri Lanka.
authors.forename: Harindra
authors.initials: H
authors.lastname: Karunathilake
authors.affiliation: Hunter Haematology Research Group, Calvary Mater Newcastle, Newcastle, New South Wales, Australia.
authors.forename: Lisa F
authors.initials: LF
authors.lastname: Lincz
authors.affiliation: Department of Clinical Medicine, Faculty of Medicine, University of Colombo, Colombo, Sri Lanka.
authors.forename: Christeine A
authors.initials: CA
authors.lastname: Gnanathasan
authors.affiliation: School of Medicine and Public Health, University of Newcastle, Callaghan, New South Wales, Australia; Department of Clinical Toxicology and Pharmacology, Calvary Mater Newcastle, Newcastle, New South Wales, Australia; South Asian Clinical Toxicology Research Collaboration (SACTRC), Faculty of Medicine, University of Peradeniya, Peradeniya, Sri Lanka.
authors.forename: Geoffrey K
authors.initials: GK
authors.lastname: Isbister
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000818:Animals; D000997:Antivenins / Q000627:therapeutic use*; D001778:Blood Coagulation Disorders / Q000097:blood* / Q000188:drug therapy / Q000209:etiology; D015331:Cohort Studies; D005260:Female; D006801:Humans; D007124:Immunoenzyme Techniques; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D017840:Daboia; D012909:Snake Bites / Q000097:blood* / Q000188:drug therapy*; D012910:Snake Venoms / Q000097:blood*; D055815:Young Adult
chemical_list: D000997:Antivenins; D012910:Snake Venoms