Coagulopathy after snake envenomation in South Korea
| Autor: | Jong-Choon Kim, Kyung-Hwa Park, Jae-Hak Moon, Y. J. Koo, Sung Do Lee, Young-Nan Cho, Dong Ki Kim, Jae-Sook Ahn, S. J. Ryu, Byeongjo Chun |
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| Rok vydání: | 2021 |
| Předmět: |
Male
medicine.medical_specialty Time Factors Snake Bites macromolecular substances Toxicology Severity of Illness Index 03 medical and health sciences 0302 clinical medicine Republic of Korea medicine Coagulopathy Animals Humans In patient 030212 general & internal medicine Envenomation Blood Coagulation Aged Retrospective Studies Clotting factor Snake envenomation business.industry Antivenins Fibrinogen 030208 emergency & critical care medicine Retrospective cohort study Consumption Coagulopathy Snakes General Medicine Disseminated Intravascular Coagulation Middle Aged medicine.disease humanities body regions Treatment Outcome Emergency medicine Factor X Female Prothrombin Blood Coagulation Tests business Biomarkers Snake Venoms |
| Zdroj: | Clinical toxicology (Philadelphia, Pa.). 59(10) |
| ISSN: | 1556-9519 |
| Popis: | This retrospective study investigated the nature and severity of venom-induced consumption coagulopathy (VICC) and determined the clotting factors involved in VICC in patients after envenomation by South Korea's snakes. Additionally, we studied the effectiveness of antivenom for the treatment of VICC after envenomation.Included patients were divided into three groups according to the severity of VICC (no VICC, partial VICC, and complete VICC). Data, including changes in coagulation parameters during hospitalization and clotting factors at presentation, were collected and analyzed.One hundred nineteen patients who presented at our emergency department within 3 h after snake envenomation were included. VICC developed in 34 patients (27 patients with partial VICC and 7 patients with complete VICC). Two of 34 patients with VICC required blood transfusions. Five patients with complete VICC had an undetectable fibrinogen concentration at presentation. Three patients with complete VICC had an unmeasurable INR and aPTT within 24 h. The median times of the most extreme values were 10 h for INR, 12 h for aPTT, and 16 h for fibrinogen after presentation in the VICC group. The D-dimer concentration peaked at a median of 63.5 h after presentation. The activities of factors II and X were significantly reduced in the complete VICC group (factor II: 88 (84-99.3)% in the non-VICC group vs. 69 (49.5-83.5)% in the complete VICC group; factor X:94 (83-102) in the non-VICC group vs. 70 (66.5-79.8)% in the complete VICC group), while there was no difference in factor V activity at presentation. The time from bite to first antivenom administration did not correlate with the time course and most extreme concentrations for fibrinogen and D-dimer within the VICC groups.VICC occurs in approximately one-quarter of snakebite patients in South Korea; however, VICC itself does not appear to lead to clinical deterioration. Fibrinogen is an early diagnostic maker for complete VICC. Clotting factors II and X are involved in VICC. Future investigations should explore the mechanism of VICC from Korean snakebites and the effect of antivenom on VICC. |
| Databáze: | OpenAIRE |
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