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Title: A Randomized controlled trial of fresh frozen plasma for coagulopathy in Russell's viper (Daboia russelii) envenoming
Authors: Isbister, G.K.
Jayamanne, S.
Mohamed, F.
Dawson, A.H.
Maduwage, K.
Gawarammana, I.
Lalloo, D.G.
de Silva, H.J.
Scorgie, F.E.
Lincz, L.F.
Buckley, N.A.
Keywords: Snake Bites
Snake Bites-therapy
Russell's Viper
Snake Venoms
Antivenins-therapeutic use
Blood Coagulation
Disseminated Intravascular Coagulation
Viper Venoms
Sri Lanka
Randomized Controlled Trial
Prospective Studies
Issue Date: 2017
Publisher: Wiley-Blackwell
Citation: Journal of Thrombosis and Haemostasis. 2017; 15(4): 645-654
Abstract: BACKGROUND: Russell's viper (Daboia russelii) envenoming is a major health issue in South Asia and causes venom induced consumption coagulopathy (VICC). OBJECTIVES: We investigated the effect 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 at two Sri Lankan hospitals. Patients with suspected Russell's viper bites and coagulopathy were randomly allocated (1:1) high-dose antivenom (20 vials) or low-dose antivenom (10 vials) plus 4U FFP. The primary outcome was the proportion of patients with an international normalized ratio (INR)<2, 6h post-antivenom. Secondary outcomes included anaphylaxis, major haemorrhage, death and clotting factor recovery. RESULTS: From 214 eligible patients, 141 were randomized; 71 to high-dose antivenom, 70 to low-dose antivenom/FFP; five had no post-antivenom bloods. The groups were similar except for a delay of 1h in antivenom administration for FFP patients. 6h post-antivenom 23/69 (33%) patients allocated high-dose antivenom had an INR<2 compared with 28/67 (42%) allocated low-dose antivenom/FFP [absolute difference 8%;95%Confidence Interval:-8% to 25%]. 15 patients allocated 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/FFP patients including one intracranial haemorrhage. There was no difference in recovery rates of INR or fibrinogen, but more rapid initial recovery of factor V and X in FFP patients. CONCLUSION: FFP post-antivenom in Russell's viper bites didn't hasten recovery of coagulopathy. Low-dose antivenom/FFP did not worsen VICC, suggesting low-dose antivenom is sufficient. This article is protected by copyright. All rights reserved.
Description: Indexed in MEDLINE
ISSN: 1538-7933 (Print)
1538-7836 (Electronic)
1538-7836 (Linking)
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