- Title
- Venom concentrations and clotting factor levels in a prospective cohort of Russell's viper bites with coagulopathy
- Creator
- Isbister, Geoffrey K.; Maduwage, Kalana; Scorgie, Fiona E.; Shahmy, Seyed; Mohamed, Fahim; Abeysinghe, Chandana; Karunathilake, Harendra; O'Leary, Margaret A.; Gnanathasan, Christeine A.; Lincz, Lisa F.
- Relation
- NHMRC.631073
- Relation
- PLoS Neglected Tropical Diseases Vol. 9, Issue 8
- Publisher Link
- http://dx.doi.org/10.1371/journal.pntd.0003968
- Publisher
- Public Library of Science
- Resource Type
- journal article
- Date
- 2015
- Description
- Background: Russell's viper envenoming is a major problem in South Asia and causes venom induced consumption coagulopathy. This study aimed to investigate the kinetics and dynamics of venom and clotting function in Russell's viper envenoming. Methodology/Principal Findings: In a prospective cohort of 146 patients with Russell's viper envenoming, we measured venom concentrations, international normalised ratio [INR], prothrombin time (PT), activated partial thromboplastin time (aPTT), coagulation factors I, II, V, VII, VIII, IX and X, and von Willebrand factor antigen. The median age was 39y (16-82y) and 111 were male. The median peak INR was 6.8 (interquartile range[IQR]:3.7 to >13), associated with low fibrinogen [median,<0.01g/L;IQR:<0.01-0.9g/L), low factor V levels [median,<5%;IQR:<5-4%], low factor VIII levels [median,40%;IQR:12-79%] and low factor X levels [median,48%; IQR:29-67%]. There were smaller reductions in factors II, IX and VII over time. All factors recovered over 48h post-antivenom. The median INR remained >3 at 6h post-antivenom but had reduced to <2, by 24h. The aPTT had also returned to close to normal (<50sec) at 24h. Factor VII, VIII and IX levels were unusually high pre-antivenom, median peak concentrations of 393%, 307% and 468% respectively. Pre-antivenom venom concentrations and the INR (r=0.20, p=0.02) and aPTT (r=0.19, p=0.03) were correlated (non-parametric Spearman analysis). Conclusions: Russell's viper coagulopathy results in prolonged aPTT, INR, low fibrinogen, factors V, VIII and X which recover over 48h. Severity of clotting abnormalities was associated with venom concentrations.
- Subject
- Russell's viper; venom; coagulation; clotting factor levels
- Identifier
- http://hdl.handle.net/1959.13/1334862
- Identifier
- uon:27369
- Identifier
- ISSN:1935-2727
- Rights
- © 2015 Isbister et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited
- Language
- eng
- Full Text
- Reviewed
- Hits: 4128
- Visitors: 4885
- Downloads: 462
| Thumbnail | File | Description | Size | Format | |||
|---|---|---|---|---|---|---|---|
| View Details Download | ATTACHMENT02 | Publisher version (open access) | 730 KB | Adobe Acrobat PDF | View Details Download |