Subacute coagulopathy in a randomized, comparative trial of Fab and F(ab′)2 antivenoms

Boyer, Leslie V.; Chase, Peter B.; Degan, Janice A.; Figge, Gary R.; Buelna-Romero, Alma; Luchetti, Cynthia; Alagón, Alejandro

doi:10.1016/j.toxicon.2013.07.018

Cited by 53 publications

(30 citation statements)

References 15 publications

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“…There are a few reports where there is both definite recurrence of venom in serum associated with re-envenoming. This has been most recently 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 reported with crotaline envenoming in North America (Boyer et al, 2013). It appears that in cases where venom is detected postantivenom this is not always associated with re-envenoming and it may be that the venom specific ELISA is detecting more than just free venom (O'leary and Isbister, 2014).…”

Section: Introductionmentioning

confidence: 86%

“…In its most pure form the phenomena of recurrence is the reappearance of venom in the circulation which is associated with a recrudescence of envenoming symptoms, signs and laboratory changes (Boyer et al, 2013). Most authors suggest that this is a result of insufficient antivenom being administered and as further venom is absorbed from the bite site, the antivenom is overwhelmed and the patient is re-envenomed (Ho et al, 1986;Theakston et al, 1992).…”

Section: Introductionmentioning

confidence: 99%

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Detection of venom after antivenom administration is largely due to bound venom

O’Leary

Maduwage

2015

Toxicon

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Section: Introductionmentioning

confidence: 86%

Section: Introductionmentioning

confidence: 99%

Detection of venom after antivenom administration is largely due to bound venom

O’Leary

Maduwage

2015

Toxicon

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“…[10] Consequently, prior trials have primarily used diagnosis-oriented endpoints, such as surrogate markers of coagulopathy, as primary outcomes. [11][12][13][14][15] Outcome measures that are patient centered and ideally patient reported will yield the most informative and clinically relevant information from the clinical trials evaluating potential snake envenomation therapies. [16] The Patient-Specific Functional Scale (PSFS) is a widely used patient-reported outcome measure that identifies a short list of patient-chosen activities limited by the disease.…”

Section: Methodsmentioning

confidence: 99%

The validity, reliability and minimal clinically important difference of the patient specific functional scale in snake envenomation

Gerardo

Vissoci

Anderson

et al. 2018

Toxicon

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ObjectiveValid, reliable, and clinically relevant outcome measures are necessary in clinical studies of snake envenomation. The aim of this study was to evaluate the psychometric (validity and reliability) and clinimetric (minimal clinically important difference [MCID]) properties of the Patient-Specific Functional Scale (PSFS) in snakebite envenomation. assessments. The MCID was evaluated using the following criteria: (1) the distribution of stable patients according to both standard error of measurement (SEM) and responsiveness techniques, and (2) anchor-based methods to compare between individuals and to detect discriminant ability of a positive change with a receiver operator characteristic (ROC) curve and optimal cutoff point. ResultsA total of 86 patients were evaluated in this study. The average PSFS scores were 5.37 (SD 3.23), 7.95 (SD 2.22), and 9.12 (SD 1.37) at 3, 7, and 10 days, respectively. Negligible floor effect was observed (maximum of 8% at 3 days); however, a ceiling effect was observed at 17 days (25%). The PSFS showed good reliability with an internal consistency of 0.91 (Cronbach's alpha) (95% CI 0.88, 0.95) and a temporal stability of 0.83 (ICC) (95% CI 0.72, 0.89). The PSFS showed a strong positive correlation with quality of life and functional assessments. The MCID was approximately 1.0 for all methods. ConclusionsWith an MCID of approximately 1 point, the PSFS is a valid and reliable tool to assess quality of life and functionality in patients with snake envenomation. PSFS in snake envenomation PLOS ONE | https://doi.org/10.

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“…Now it is known that the venom lymph pool, together with the venom pool in the depot, represents a long-term source of venom that can last several days (Paniagua et al 2012). 2015 Particularly in the case of Fab antivenom therapy for rattlesnake envenomation, coagulopathic recurrence appears to reflect an approximately 2-week subacute phase of envenomation, which is unmasked when antivenom is cleared within this time (Boyer et al 2013). Fab fragments have short elimination halflife and, consequently, treatment consensus favors repeated dosing of Fab following the initial control of envenomation (Lavonas et al 2011).…”

Section: Recurrence Of Envenomation and Lymphatic Transport Of Venom mentioning

confidence: 99%

“…A clearer understanding of the role of the intrinsic inflammatory response could lead to the more rational use of adjunctive therapies in critically ill patients. And subacute toxicodynamic studies could lead to a better balance of wound management and coagulopathy prevention during the subacute phase of disease, when ongoing envenomation and early tissue healing may take place simultaneously (Boyer et al 2013). Mora et al (2008) considered the effects of viper snake venom on lymphatic vessels as the hidden aspect of envenomation.…”

Section: Use Of the Pressure Immobilization Technique To Retard Systementioning

confidence: 99%

Role of Lymphatic System on Snake Venom Absorption

et al. 2015

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For several decades, advances have been made in venom characterization, mechanism of toxicity, and antivenom therapy. Much of this research has been based on models of the blood vascular system, to analyze the pharmacokinetics of venoms and antivenoms. However, in clinical envenomations, venom is injected into the interstitial space and an absorption process is necessary before it reaches the bloodstream. Absorption may occur by way of the blood or lymphatic capillaries, depending on the physicochemical properties of the molecules involved. Until recently, the role of the lymphatics in envenomation remained essentially unexplored, although several reports have demonstrated the fundamental role of the lymphatic system in the absorption of therapeutic proteins, administered subcutaneously. This review describes the absorption process, from the interstitial space and extracellular matrix through the entry into the blood capillaries and early lymphatics. Venom toxins interact with hyaluronic acid in the extracellular matrix, facilitating interstitial spread before entry into the vessels, and they induce local damage to the vascular endothelium, resulting in local hemorrhage and edema and altering the absorption characteristics of damaged vessels. Large molecules are absorbed primarily via the lymphatics, providing them a fundamentally different toxicokinetic profile from that of smaller toxins for which direct access to the blood capillaries is possible. Improved knowledge of the mechanism and factors influencing the subcutaneous venom absorption can improve the understanding of the role of edema, patterns of local injury, the toxicokinetics of envenomation, the effect of pressure immobilization, the pharmacodynamics and dosing of antivenom, and the phenomenon of recurrent venom effect.

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Subacute coagulopathy in a randomized, comparative trial of Fab and F(ab′)2 antivenoms

Cited by 53 publications

References 15 publications

Detection of venom after antivenom administration is largely due to bound venom

Detection of venom after antivenom administration is largely due to bound venom

The validity, reliability and minimal clinically important difference of the patient specific functional scale in snake envenomation

Role of Lymphatic System on Snake Venom Absorption

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