Xavier Heckmann1,2, Véronique Lambert3, Georges Mion4, Adrien Ehrhardt5, Christian Marty2, Frédérique Perotti6, Jean-François Carod7, Anne Jolivet8, David Boels9, Ibrahim Lehida Andi10, Sébastien Larréché11. 1. Department of Emergency, Western Guiana Hospital, Saint-Laurent-du-Maroni, French Guiana. 2. French Red Cross, Cayenne, French Guiana. 3. Department of Obstetrics and Gynaecology, Western Guiana Hospital, Saint-Laurent-du-Maroni, French Guiana. 4. Department of Anaesthesiology, Cochin Hospital, Paris, France. 5. INRIA Lille-Nord Europe, Villeneuve-d'Ascq, France. 6. Department of Pharmacy, Western Guiana Hospital, Saint-Laurent-du-Maroni, French Guiana. 7. Department of Medical Biology, Western Guiana Hospital, Saint-Laurent-du-Maroni, French Guiana. 8. Department of Public Health, Western Guiana Hospital, Saint-Laurent-du-Maroni, French Guiana. 9. Poison Control Center, Angers University Hospital, Angers, France. 10. Department of Anaesthesiology and Reanimation, Western Guiana Hospital, Saint-Laurent-du-Maroni, French Guiana. 11. Department of Medical Biology, Bégin Military Teaching Hospital, Saint-Mandé, France.
Abstract
Introduction: In French Guiana, most snakebites are caused by crotalids, with the main signs being tissue damage and bleeding due to venom-induced coagulopathy. Since December 2014 the Western Guiana Hospital (WGH) has used Antivipmyn TriTM, a Mexican polyvalent antivenom. The aim of the study was to assess its benefit on the correction of snakebite-related coagulopathy. Methods: This retrospective study included patients hospitalized at the WGH with snakebite and a coagulopathy defined by: a prothrombin rate (PR) lower than 45%, an activated partial thromboplastin time ratio (aPTTr) greater than 2 or a fibrinogen lower than 100 mg.dL-1. The antivenom group included patients receiving Antivipmyn TriTM from December 2014 to September 2017. The control group included patients admitted between January 2013 and November 2014 (when antivenom was unavailable) or admitted between December 2014 and September 2017 during times of antivenom shortage. We graphically compared the time courses of PR, aPTTr and fibrinogen between groups. Other endpoints were the length of hospital stay and the need for surgery or dialysis. Results: 84 patients were included: 42 in the antivenom group, 42 in the control group. Both groups were similar for age, sex-ratio, proportion of bleedings, necrosis, and severity. Most patients in the antivenom group received 3 vials. There were no significant differences in recovery of PR, aPTTr and fibrinogen through the first 24 h. Fibrinogen declined again in the control group at 30 h and showed a slower rise to normal concentration. There were no significant differences in any secondary endpoint. Conclusion: Antivipmyn TriTM as currently used did not show any benefit in recovery from coagulopathy.
Introduction: In French Guiana, most snakebites are caused by crotalids, with the main signs being tissue damage and bleeding due to venom-induced coagulopathy. Since December 2014 the Western Guiana Hospital (WGH) has used Antivipmyn TriTM, a Mexican polyvalent antivenom. The aim of the study was to assess its benefit on the correction of snakebite-related coagulopathy. Methods: This retrospective study included patients hospitalized at the WGH with snakebite and a coagulopathy defined by: a prothrombin rate (PR) lower than 45%, an activated partial thromboplastin time ratio (aPTTr) greater than 2 or a fibrinogen lower than 100 mg.dL-1. The antivenom group included patients receiving Antivipmyn TriTM from December 2014 to September 2017. The control group included patients admitted between January 2013 and November 2014 (when antivenom was unavailable) or admitted between December 2014 and September 2017 during times of antivenom shortage. We graphically compared the time courses of PR, aPTTr and fibrinogen between groups. Other endpoints were the length of hospital stay and the need for surgery or dialysis. Results: 84 patients were included: 42 in the antivenom group, 42 in the control group. Both groups were similar for age, sex-ratio, proportion of bleedings, necrosis, and severity. Most patients in the antivenom group received 3 vials. There were no significant differences in recovery of PR, aPTTr and fibrinogen through the first 24 h. Fibrinogen declined again in the control group at 30 h and showed a slower rise to normal concentration. There were no significant differences in any secondary endpoint. Conclusion: Antivipmyn TriTM as currently used did not show any benefit in recovery from coagulopathy.
Entities:
Keywords:
Bothrops atrox; French Guiana; Snakebite; coagulopathy; crotalinae; immunotherapy
Authors: Lachlan A Bourke; Christina N Zdenek; Edgar Neri-Castro; Melisa Bénard-Valle; Alejandro Alagón; José María Gutiérrez; Eladio F Sanchez; Matt Aldridge; Bryan G Fry Journal: Toxins (Basel) Date: 2021-01-22 Impact factor: 4.546