<i>Hypnale</i> Coagulopathy: Snake Envenomation of a Different Kind

Naik, Bolar

doi:10.4997/jrcpe.2021.108

Cited by 6 publications

(10 citation statements)

References 27 publications

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“…A study of acute kidney injury in Russell's viper bites found that 5 of 24 patients with AKIN Stage 1 and 5 of 13 patients with AKIN Stage 2 had a normal WBCT, similar to the group in our study (28). Similarly, in hump-nosed viper bites, the majority of patients have a normal WBCT and minor systemic symptoms, but a small proportion develop AKI, not always with an abnormal WBCT (29)(30)(31)(32). Although many of these patients with mild VICC may not develop complications, previous studies demonstrate that there is a small but important group of patients with mild VICC who go on to develop AKI, often requiring dialysis and rarely being fatal (31,32).…”

Section: Discussionsupporting

confidence: 81%

Indian Polyvalent Antivenom Accelerates Recovery From Venom-Induced Consumption Coagulopathy (VICC) in Sri Lankan Russell’s Viper (Daboia russelii) Envenoming

et al. 2022

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BackgroundVenom-induced consumption coagulopathy (VICC) is an important clinical consequence of Russell’s viper (Daboia russelii) envenoming. There is limited evidence for antivenom effectiveness in resolving VICC. We aimed to compare the recovery of VICC in patients who received and did not receive antivenom following Russell’s viper envenoming.Patients and MethodsThis was a non-randomized observational study comparing patients with VICC from Russell’s viper envenoming given antivenom for systemic envenoming and those not given antivenom. Antivenom administration was decided by the treating physicians. We included 44 patients with confirmed Russell’s viper bites with one or more International Normalized Ratio (INR) value ≥ 1.5 (VICC). We compared five patients who did not receive antivenom with 39 patients who did receive antivenom. The primary outcome was the proportion of patients with an INR < 1.5 by 48 h post-bite.ResultsThe antivenom group had higher peak serum venom concentrations [median (IQR) = 272 (96–1,076) ng/mL versus 21 (8–58) ng/mL] and more severe VICC compared to the no antivenom group. Twenty seven of 39 patients (69%) in the antivenom group had an INR < 1.5 at 48 h post-bite compared to none of the five patients (0%) in the no antivenom group (absolute difference: 69%; 95%CI: 13 to 83%; p = 0.006; Fisher’s exact test). The fibrinogen recovered in 32 of 39 patients (82%) in the antivenom group compared to one of five patients (20%) in the no antivenom group (absolute difference 62%; 95% CI: 28 to 95%; p = 0.001; Fisher’s exact test). Both INR and fibrinogen were significantly improved between 24 and 48 h post-bite in the antivenom group compared to the no antivenom group.ConclusionAntivenom accelerated the recovery of VICC in patients with Russell’s viper envenoming, compared to no recovery in a smaller group of patients with milder VICC not receiving antivenom. This supports the efficacy of antivenom in patients with VICC.

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Section: Discussionsupporting

confidence: 81%

Indian Polyvalent Antivenom Accelerates Recovery From Venom-Induced Consumption Coagulopathy (VICC) in Sri Lankan Russell’s Viper (Daboia russelii) Envenoming

et al. 2022

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“…This may be explained by absence of hump-nosed pit viper ( Hypnale hypnale ), the principal contributor to PDF, 7,25,26 along the eastern coast of India where this study site is situated. Further, PDF may develop late 7,26 and VICC was evaluated for only first 24 h post-enrolment in this study. About 13% of patients with bleeding did not have DIC (overt/non-overt), PDF or thrombocytopenia <50 × 10 9 /L (Figure 2).…”

Section: Discussionmentioning

confidence: 94%

“…Higher frequency of Hypnale bites in Sri Lankan studies 11,27 can explain lower 20WBCT sensitivity in them, as 20WBCT is less sensitive for detecting VICC in Hypnale envenomation. 26,28,29 Further, geographical variations in the distribution of different viper species and their venom composition and non-standardised techniques employed for 20WBCT in previous studies 27 can account for variability in sensitivity and specificity of 20WBCT. Nearly 10% of patients with positive 20WBCTs had false positive 20WBCTs in this study, similar to 25% reported in a previously study.…”

Section: Discussionmentioning

confidence: 99%

Venom induced consumption coagulopathy and performance of 20-min whole blood clotting test for its detection in viperid envenomation

Rajkumar

Vinod

Kar

et al. 2022

Journal of the Royal College of Physicians of Edinburgh

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Background: Venom induced consumption coagulopathy (VICC) and its underlying mechanisms have not been fully elucidated in viperid envenomation (VE), especially among Indian patients. We evaluated for VICC in VE, assessed the performance of 20-min whole blood clotting test (20WBCT) for VICC detection and also studied predictors of VICC. Methods: This hospital-based observational study enrolled 103 consecutive patients (age ⩾ 12 years) of snakebite admitted within 24 h of bite, with features of VE. They underwent 20WBCT, prothrombin time (PT)/international normalised ratio (INR), plasma fibrinogen and D-dimer testing during first 24 h after enrolment. Overt VICC (defined by overt bleeding), subclinical VICC (INR ⩾ 1.4 and/or fibrinogen < 2g/L, without overt bleeding), disseminated intravascular coagulation (DIC) (overt/non-overt, defined based on International Society on Thrombosis and Haemostasis (ISTH) DIC score) and primary defibrination (PDF) were evaluated among patients. Results: VICC overall was noted in 77 (≈75%) and overt VICC in 52 (≈50%). DIC (overt/non-overt) was noted in 59 (≈77%) and PDF in 2 (2.6%) patients with VICC. Sensitivity, specificity, positive predictive value and negative predictive value of 20WBCT for VICC detection were 98.7% (95%CI: 92.9–99.9%), 65.4% (95%CI: 44.3–82.8%), 89.4% (95%CI: 83.3–93.5%) and 94.4% (95%CI: 70.4–99.2%) respectively. Severe cellulitis in bitten limb predicted reduced VICC risk. Conclusion: Majority (75%) of patients with VE had VICC and 68% with VICC had overt bleeding. DIC (overt/non-overt) was the predominant contributor to VICC. Though 20WBCT is a good screening test for VICC, false positive results should be kept in mind before deciding on snake antivenom treatment.

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“…We hope that a comprehensive review by Dr Naik in this issue of the Journal on Hypnale enveomation will draw the attention of physicians worldwide and help generate support for relevant initiatives in their areas. 11…”

mentioning

confidence: 99%