Study of coagulation disorder following haemotoxic snake envenomation in a tertiary care centre

Mubarak R., B. N. Mohapatra


Background: Coagulopathy is the most common manifestation in cases of haemotoxic snake bites. The most common coagulopathy associated with snake envenoming worldwide is venom-induced consumption coagulopathy (VICC). The existence of overlapping clinical syndromes of VICC and thrombotic microangiopathy (TMA) in snake envenoming is the likely reason for the mistaken idea that snake bite causes disseminated intravascular coagulation (DIC). This study aims to look into the exact type coagulopathy in haemotoxic snake envenomation.

Methods: Prospective observational study was conducted from January 2017 to January 2018 at a tertiary care centre in Odisha.

Results: Out of 54, 23 (42.6%) cases were having DIC and 31 (57.4%) cases were not confirmed to be having DIC. In DIC group there was significantly delayed hospitalization (46.3±28.5 hours) when compared to group B (13.5±11.1 hours, p<0.05). Mean anti-snake venom (ASV) requirement in DIC group was significantly higher (28.3±14) than in those DIC is not confirmed (11.13±3.1, p<0.05). 21.7% cases in DIC group had kdigo stage III AKI compared to 3.3%cases of group B. 13% cases of DIC group required hemodialysis when compared to 3.2% cases of group B.

Conclusions: Early hospitalisation (preferably <12 hours and not >24 hours), early ASV administration are important to prevent full blown DIC and more serious complications. Most of the non DIC cases appears to be DIC in evolution but not confirmed to diagnosis by DIC scoring system as they reached hospital early before the development of frank DIC. TMA has not been found in this study. However further studies are needed to ascertain the exact cause of coagulopathy in non DIC group.


Snakebite, DIC, TMA, AKI, ASV

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