Clotting factor replacement and recovery from snake venom-induced consumptive coagulopathy

S BROWN, N CARUSO, M BORLAND, D MCCOUBRIE, A CELENZA, Geoffrey Isbister

    Research output: Contribution to journalArticleResearchpeer-review

    Abstract

    Introduction: Using clotting factors (fresh frozen plasma and/or cryoprecipitate) to treat snake venom-induced consumptive coagulopathy (VICC) is controversial. We aimed to determine if factor replacement after antivenom is associated with an earlier return of coagulation function. Methods: We retrospectively analysed VICC cases due to brown snake (genus Pseudonaja), tiger snake (Notechis, Tropidechis, and Hoplocephalus), and taipan (Oxyuranus) envenoming. Recovery of international normalized ratio (INR)/prothrombin time (PT) was compared between patients who did not receive factor replacement and those who did, and between patients who received factor replacement ? 4 h of commencing antivenom and those who received factor replacement later or not at all. Results: There was no significant difference between cases receiving clotting factors and cases that did not, however in 21 cases having factor replacement within 4 h, the median time to coagulation recovery was 4.6 h (interquartile range [IQR] 3.5-8.8), versus 9.5 h (IQR 7.3-13) in 106 cases who had clotting factors later or not at all (P < 0.001). No serious adverse effects attributed to clotting factors were recorded. Recovery by 6 h after starting antivenom was also more likely in those who were younger, in tiger snake envenoming, and where the interval between bite and starting antivenom was longer. The initial dose of antivenom did not appear to influence the likelihood of recovery at 6 h. Conclusion: Early factor replacement after antivenom is associated with earlier improvement of coagulation function. Randomised controlled clinical trials to determine the efficacy and safety of factor replacement for VICC after venom neutralisation are required. � 2009 Springer-Verlag.
    Original languageEnglish
    Pages (from-to)1532-1538
    Number of pages7
    JournalIntensive Care Medicine
    Volume35
    Issue number9
    Publication statusPublished - 2009

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    Antivenins
    Snake Venoms
    Blood Coagulation Factors
    Snakes
    Venoms
    International Normalized Ratio
    Prothrombin Time
    Bites and Stings
    Randomized Controlled Trials
    Safety

    Cite this

    BROWN, S., CARUSO, N., BORLAND, M., MCCOUBRIE, D., CELENZA, A., & Isbister, G. (2009). Clotting factor replacement and recovery from snake venom-induced consumptive coagulopathy. Intensive Care Medicine, 35(9), 1532-1538.
    BROWN, S ; CARUSO, N ; BORLAND, M ; MCCOUBRIE, D ; CELENZA, A ; Isbister, Geoffrey. / Clotting factor replacement and recovery from snake venom-induced consumptive coagulopathy. In: Intensive Care Medicine. 2009 ; Vol. 35, No. 9. pp. 1532-1538.
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    abstract = "Introduction: Using clotting factors (fresh frozen plasma and/or cryoprecipitate) to treat snake venom-induced consumptive coagulopathy (VICC) is controversial. We aimed to determine if factor replacement after antivenom is associated with an earlier return of coagulation function. Methods: We retrospectively analysed VICC cases due to brown snake (genus Pseudonaja), tiger snake (Notechis, Tropidechis, and Hoplocephalus), and taipan (Oxyuranus) envenoming. Recovery of international normalized ratio (INR)/prothrombin time (PT) was compared between patients who did not receive factor replacement and those who did, and between patients who received factor replacement ? 4 h of commencing antivenom and those who received factor replacement later or not at all. Results: There was no significant difference between cases receiving clotting factors and cases that did not, however in 21 cases having factor replacement within 4 h, the median time to coagulation recovery was 4.6 h (interquartile range [IQR] 3.5-8.8), versus 9.5 h (IQR 7.3-13) in 106 cases who had clotting factors later or not at all (P < 0.001). No serious adverse effects attributed to clotting factors were recorded. Recovery by 6 h after starting antivenom was also more likely in those who were younger, in tiger snake envenoming, and where the interval between bite and starting antivenom was longer. The initial dose of antivenom did not appear to influence the likelihood of recovery at 6 h. Conclusion: Early factor replacement after antivenom is associated with earlier improvement of coagulation function. Randomised controlled clinical trials to determine the efficacy and safety of factor replacement for VICC after venom neutralisation are required. � 2009 Springer-Verlag.",
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    BROWN, S, CARUSO, N, BORLAND, M, MCCOUBRIE, D, CELENZA, A & Isbister, G 2009, 'Clotting factor replacement and recovery from snake venom-induced consumptive coagulopathy', Intensive Care Medicine, vol. 35, no. 9, pp. 1532-1538.

    Clotting factor replacement and recovery from snake venom-induced consumptive coagulopathy. / BROWN, S; CARUSO, N; BORLAND, M; MCCOUBRIE, D; CELENZA, A; Isbister, Geoffrey.

    In: Intensive Care Medicine, Vol. 35, No. 9, 2009, p. 1532-1538.

    Research output: Contribution to journalArticleResearchpeer-review

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    T1 - Clotting factor replacement and recovery from snake venom-induced consumptive coagulopathy

    AU - BROWN, S

    AU - CARUSO, N

    AU - BORLAND, M

    AU - MCCOUBRIE, D

    AU - CELENZA, A

    AU - Isbister, Geoffrey

    PY - 2009

    Y1 - 2009

    N2 - Introduction: Using clotting factors (fresh frozen plasma and/or cryoprecipitate) to treat snake venom-induced consumptive coagulopathy (VICC) is controversial. We aimed to determine if factor replacement after antivenom is associated with an earlier return of coagulation function. Methods: We retrospectively analysed VICC cases due to brown snake (genus Pseudonaja), tiger snake (Notechis, Tropidechis, and Hoplocephalus), and taipan (Oxyuranus) envenoming. Recovery of international normalized ratio (INR)/prothrombin time (PT) was compared between patients who did not receive factor replacement and those who did, and between patients who received factor replacement ? 4 h of commencing antivenom and those who received factor replacement later or not at all. Results: There was no significant difference between cases receiving clotting factors and cases that did not, however in 21 cases having factor replacement within 4 h, the median time to coagulation recovery was 4.6 h (interquartile range [IQR] 3.5-8.8), versus 9.5 h (IQR 7.3-13) in 106 cases who had clotting factors later or not at all (P < 0.001). No serious adverse effects attributed to clotting factors were recorded. Recovery by 6 h after starting antivenom was also more likely in those who were younger, in tiger snake envenoming, and where the interval between bite and starting antivenom was longer. The initial dose of antivenom did not appear to influence the likelihood of recovery at 6 h. Conclusion: Early factor replacement after antivenom is associated with earlier improvement of coagulation function. Randomised controlled clinical trials to determine the efficacy and safety of factor replacement for VICC after venom neutralisation are required. � 2009 Springer-Verlag.

    AB - Introduction: Using clotting factors (fresh frozen plasma and/or cryoprecipitate) to treat snake venom-induced consumptive coagulopathy (VICC) is controversial. We aimed to determine if factor replacement after antivenom is associated with an earlier return of coagulation function. Methods: We retrospectively analysed VICC cases due to brown snake (genus Pseudonaja), tiger snake (Notechis, Tropidechis, and Hoplocephalus), and taipan (Oxyuranus) envenoming. Recovery of international normalized ratio (INR)/prothrombin time (PT) was compared between patients who did not receive factor replacement and those who did, and between patients who received factor replacement ? 4 h of commencing antivenom and those who received factor replacement later or not at all. Results: There was no significant difference between cases receiving clotting factors and cases that did not, however in 21 cases having factor replacement within 4 h, the median time to coagulation recovery was 4.6 h (interquartile range [IQR] 3.5-8.8), versus 9.5 h (IQR 7.3-13) in 106 cases who had clotting factors later or not at all (P < 0.001). No serious adverse effects attributed to clotting factors were recorded. Recovery by 6 h after starting antivenom was also more likely in those who were younger, in tiger snake envenoming, and where the interval between bite and starting antivenom was longer. The initial dose of antivenom did not appear to influence the likelihood of recovery at 6 h. Conclusion: Early factor replacement after antivenom is associated with earlier improvement of coagulation function. Randomised controlled clinical trials to determine the efficacy and safety of factor replacement for VICC after venom neutralisation are required. � 2009 Springer-Verlag.

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    BROWN S, CARUSO N, BORLAND M, MCCOUBRIE D, CELENZA A, Isbister G. Clotting factor replacement and recovery from snake venom-induced consumptive coagulopathy. Intensive Care Medicine. 2009;35(9):1532-1538.