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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 Antivenins-therapeutic use Blood Coagulation Disseminated Intravascular Coagulation Plasma 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 |
URI: | http://repository.kln.ac.lk/handle/123456789/16015 |
ISSN: | 1538-7933 (Print) 1538-7836 (Electronic) 1538-7836 (Linking) |
Appears in Collections: | Journal/Magazine Articles |
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File | Description | Size | Format | |
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J Thromb Haemost_2017_15(4)_645.pdf | 390.1 kB | Adobe PDF | View/Open |
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