Characterization of hypofibrinogenemia following rattlesnake envenomation treated with crotalidae immune F(ab')₂ (equine) antivenom.

IF 3 3区医学 Q2 TOXICOLOGY Clinical Toxicology Pub Date : 2024-09-25 DOI:10.1080/15563650.2024.2406427

Thom S Maciulewicz, David R Axon, Farshad Mazda Shirazi

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Abstract

Introduction: Hemotoxicity is common following rattlesnake envenomation. Published experiences with equine-derived crotalidae immune F(ab')₂ antivenom have characterized hemotoxicity as delayed, recurrent, or persistent. This study investigated recovery of hypofibrinogenemia following rattlesnake envenomation treated with equine-derived crotalidae immune F(ab')₂ antivenom.

Methods: This is a retrospective analysis of human rattlesnake envenomations reported to the Arizona Poison and Drug Information Center over four years. We included rattlesnake-envenomated patients who developed hypofibrinogenemia (<1,500 mg/L) and were treated with equine-derived crotalidae immune F(ab')₂ antivenom. The primary outcomes were recovery period (h) and recovery rate (mg/L/h) of hypofibrinogenemia following equine-derived crotalidae immune F(ab')₂ antivenom administration. Collected data included demographics, laboratory values, and antivenom administered. Statistics used were percentages, medians, and Kruskall-Wallis test.

Results: There were 527 rattlesnake envenomations treated with antivenom, of which 80 met the inclusion criteria. Patients receiving treatment with F(ab')₂ antivenom and had a median fibrinogen concentration recovery rate of 62.3 mg/L/h (IQR: 42.0-74.3 mg/L/h) and median recovery period of 19.2 h (IQR: 13.8-26.2 h). There were statistically significant differences between categories for time to antivenom for the median recovery period (P = 0.0154).

Discussion: Hypofibrinogenemia is a common laboratory finding following rattlesnake envenomation in Arizona. This study investigated rattlesnake envenomated patients treated with F(ab')₂ antivenom and monitored fibrinogen concentrations as a surrogate marker of venom toxicity. Additionally, time to administration of F(ab')₂ antivenom was a statistical significant marker of the recovery period from hypofibrinogenemia. Limitations of this study included the geographic coverage of the poison center and exclusion of patients with insufficient laboratory monitoring or those who received another antivenom.

Conclusions: Following rattlesnake envenomation in Arizona, recovery from hypofibrinogenemia was able characterized in a rate (mg/L/h) and period (h) with the quantity and time to administration of antivenom. More studies are needed to assess this finding with other antivenoms and its clinical significance.

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响尾蛇中毒后使用巴豆科免疫 F(ab')2（马）抗蛇毒血清治疗的低纤维蛋白原血症的特征。

导言：响尾蛇蛇毒中毒后常见血液毒性。已发表的使用马源性巴豆科免疫 F(ab')2 抗蛇毒血清的经验将血液毒性描述为延迟性、复发性或持续性。本研究调查了响尾蛇蛇毒中毒后使用马源性羊角风科免疫 F(ab')2 抗蛇毒血清治疗后低纤维蛋白原血症的恢复情况：这是一项对亚利桑那州毒物和药物信息中心四年来收到的响尾蛇致人类中毒报告的回顾性分析。我们纳入了出现低纤维蛋白原血症（2 型抗蛇毒血清）的响尾蛇中毒患者。主要结果是服用马源性巴豆科免疫 F(ab')2 抗蛇毒血清后低纤维蛋白原血症的恢复期（小时）和恢复率（毫克/升/小时）。收集的数据包括人口统计学特征、实验室值和所注射的抗蛇毒血清。使用的统计量包括百分比、中位数和 Kruskall-Wallis 检验：共有 527 例响尾蛇咬伤患者接受了抗蛇毒血清治疗，其中 80 例符合纳入标准。接受 F(ab')2 抗蛇毒血清治疗的患者纤维蛋白原浓度恢复率中位数为 62.3 mg/L/h（IQR：42.0-74.3 mg/L/h），恢复期中位数为 19.2 h（IQR：13.8-26.2 h）。在抗蛇毒血清时间和中位恢复期方面，不同类别之间的差异具有统计学意义（P = 0.0154）：讨论：低纤维蛋白原血症是亚利桑那州响尾蛇咬伤后常见的实验室结果。本研究调查了接受 F(ab')2 抗蛇毒血清治疗的响尾蛇中毒患者，并将纤维蛋白原浓度作为蛇毒毒性的替代指标进行监测。此外，服用 F（ab'）2 抗蛇毒血清的时间是低纤维蛋白原血症恢复期的重要统计学标志。这项研究的局限性包括毒物中心的地理覆盖范围以及排除了实验室监测不足的患者或接受过其他抗蛇毒血清的患者：结论：在亚利桑那州发生响尾蛇咬伤后，低纤维蛋白原血症的恢复速度（毫克/升/小时）和时间（小时）与抗蛇毒血清的用量和用药时间有关。需要进行更多的研究，以评估这一发现与其他抗蛇毒血清的关系及其临床意义。

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来源期刊

Clinical Toxicology 医学-毒理学

CiteScore

5.70

自引率

12.10%

发文量

148

审稿时长

4-8 weeks

期刊介绍： clinical Toxicology publishes peer-reviewed scientific research and clinical advances in clinical toxicology. The journal reflects the professional concerns and best scientific judgment of its sponsors, the American Academy of Clinical Toxicology, the European Association of Poisons Centres and Clinical Toxicologists, the American Association of Poison Control Centers and the Asia Pacific Association of Medical Toxicology and, as such, is the leading international journal in the specialty.