Acute Crit Care.  2019 Nov;34(4):269-275. 10.4266/acc.2019.00591.

Risk factor, monitoring, and treatment for snakebite induced coagulopathy: a multicenter retrospective study

• Jeon YJ
• Kim JW
• Park S
• Shin DW

• KMID: 2467306
• DOI: http://doi.org/10.4266/acc.2019.00591

Abstract

BACKGROUND
Snakebite can cause various complications, including coagulopathy. The clinical features of snakebite-associated coagulopathy differ from those of disseminated intravascular coagulation (DIC) caused by other diseases and its treatment is controversial.
METHODS
We retrospectively reviewed the medical records of patients hospitalized for snakebite between January 2006 and September 2018.
RESULTS
A total of 226 patients were hospitalized due to snakebite. Their median hospital stay was 4.0 days (interquartile range, 2.0 to 7.0 days). Five patients arrived at hospital with shock and one patient died. Twenty-one patients had overt DIC according to the International Society of Thrombosis and Hemostasis scoring system. Two patients developed major bleeding complications. Initial lower cholesterol level at presentation was associated with the development of overt DIC. International normalization ratio (INR) exceeding the laboratory's measurement limit was recorded as late as 4 to 5 days after the bite. Higher antivenom doses (≥18,000 units) and transfusion of fresh frozen plasma (FFP) or cryoprecipitate did not affect prolonged INR duration or hospital stay in the overt DIC patients without bleeding.
CONCLUSIONS
Initial lower cholesterol level may be a risk factor for overt DIC following snakebite. Although patients lack apparent symptoms, the risk of coagulopathy should be assessed for at least 4 to 5 days following snakebite. Higher antivenom doses and transfusion of FFP or cryoprecipitate may be unbeneficial for coagulopathic patients without bleeding.

Keyword

antivenom; blood transfusion; consumption coagulopathies; disseminated intravascular coagulopathy; snakebite

MeSH Terms

Blood Transfusion
Cholesterol
Dacarbazine
Disseminated Intravascular Coagulation
Hemorrhage
Hemostasis
Humans
International Normalized Ratio
Length of Stay
Medical Records
Plasma
Retrospective Studies*
Risk Factors*
Shock
Snake Bites*
Thrombosis
Cholesterol
Dacarbazine

Figure

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  Figure 1. The receiver operation characteristic curve of initial cholesterol level and overt disseminated intravascular coagulation. AUC: area under the curve; CI: confidence interval.

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