- Title
- A randomized controlled trial of fresh frozen plasma for coagulopathy in Russell's viper (Daboia russelii) envenoming
- Creator
- Isbister, G. K.; Jayamanne, S.; Buckley, N. A.; Mohamed, F.; Dawson, A. H.; Maduwage, K.; Gawarammana, I.; Lalloo, D. G.; de Silva, H. J.; Scorgie, F. E.; Lincz, L. F.
- Relation
- NHMRC.ID631073, NHMRC 1061041 and NHMRC 1059542 http://purl.org/au-research/grants/nhmrc/1059542
- Relation
- Journal of Thrombosis and Haemostasis Vol. 15, Issue 4, p. 645-654
- Publisher Link
- http://dx.doi.org/10.1111/jth.13628
- Publisher
- Wiley-Blackwell Publishing
- Resource Type
- journal article
- Date
- 2017
- Description
- Background: Russell’s viper (Daboia russelii) envenoming is a major health issue in South Asia and causes venom-induced consumption coagulopathy (VICC). Objectives: To investigate the effects of fresh frozen plasma (FFP) and two antivenom doses in correcting VICC. Methods: We undertook an open-label randomized controlled trial in patients with VICC attwo Sri Lankan hospitals. Patients with suspected Russell’s viper bites and coagulopathy were randomly allocated (1 : 1) to high-dose antivenom (20 vials) or low-dose antivenom (10 vials) plus 4 U of FFP. The primary outcome was the proportion of patients with an International Normalized Ratio (INR) of < 2 at 6 h after antivenom administration. Secondary outcomes included anaphylaxis, major hemorrhage, death, and clotting factor recovery. Results: From 214 eligible patients, 141 were randomized: 71 to high-dose antivenom, and 70 to low-dose antivenom/FFP; five had no post-antivenom blood tests. The groups were similar except for a delay of 1 h in antivenom administration for FFP patients. Six hours after antivenom administration, 23 of 69 (33%) patients allocated to high-dose antivenom had an INR of < 2, as compared with 28 of 67 (42%) allocated to low-dose antivenom/FFP (absolute difference 8%; 95% confidence interval - 8% to 25%). Fifteen patients allocated to FFP did not receive it. Severe anaphylaxis occurred equally frequently in each group. One patient given FFP developed transfusion-related acute lung injury. Three deaths occurred in low-dose antivenom/FFP patients, including one intracranial hemorrhage. There was no difference in recovery rates of INR or fibrinogen, but there was more rapid initial recovery of factor V and FX in FFP patients. Conclusion: FFP after antivenom administration in patients with Russell’s viper bites did not hasten recovery of coagulopathy. Low-dose antivenom/FFP did not worsen VICC, suggesting that low-dose antivenom is sufficient.
- Subject
- antivenoms; consumption coagulopathy; plasma; snake venoms; snakebites
- Identifier
- http://hdl.handle.net/1959.13/1350791
- Identifier
- uon:30614
- Identifier
- ISSN:1538-7933
- Rights
- © 2017 The Authors. Journal of Thrombosis and Haemostasis published by Wiley Periodicals, Inc. on behalf of International Society on Thrombosis and Haemostasis. This is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.
- Language
- eng
- Full Text
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