Failure of a Mexican antivenom on recovery from snakebite-related coagulopathy in French Guiana.

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 Tri TM, 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 Tri TM 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 Tri TM as currently used did not show any benefit in recovery from coagulopathy.

• Authors: Xavier Heckmann, Véronique Lambert, Georges Mion, Adrien Ehrhardt, Christian Marty, Frédérique Perotti, Jean-François Carod, Anne Jolivet, David Boels, Ibrahim Lehida Andi, Sébastien Larréché
• Journal: Clinical toxicology (Philadelphia, Pa.) (Clin Toxicol (Phila)) Vol. 59 Issue 3 Pg. 193-199 (Mar 2021) ISSN: 1556-9519 [Electronic] England
• PMID: 32609546 (Publication Type: Journal Article)

Chemical References

• Antivenins
• Crotalid Venoms

Topics

• Adolescent
• Adult
• Animals
• Antivenins (adverse effects, therapeutic use)
• Blood Coagulation Disorders (drug therapy, etiology)
• Bothrops
• Case-Control Studies
• Crotalid Venoms (antagonists & inhibitors)
• Crotalinae
• Crotalus
• Female
• French Guiana
• Humans
• Male
• Middle Aged
• Retrospective Studies
• Snake Bites (drug therapy)
• Treatment Failure
• Viperidae
• Young Adult