Dr. Heitor Vieira Dourado Tropical Medicine Foundation, Carlos Borborema Clinical Research Institute, Manaus, Brazil.
College of Health Sciences, University of the State of Amazonas, Manaus, Brazil.
Clin Toxicol (Phila). 2020 Apr;58(4):266-274. doi: 10.1080/15563650.2019.1634273. Epub 2019 Jul 2.
snakebites are a major public health problem in the Amazon region and also cause hemostatic disorders. In this study, we assessed the recovery from hemostatic disorders in snakebite patients after being given antivenom therapy. This is a prospective study of snakebite patients ( = 100) treated at the , Manaus, Brazilian Amazon, between January 2016 and December 2017. Blood samples were taken for the measurement of venom concentrations, platelets, clotting time and factors of patients on admission, 12, 24 and 48 h after antivenom therapy, and taken again on discharge. The presence of systemic bleeding was recorded during the follow-up. On admission, systemic bleeding was observed in 14% of the patients. Thrombocytopenia was noted in 10% of the patients. A total of 54% of the patients presented unclottable blood with low levels of fibrinogen and alpha 2-antiplasmin, and high levels of fibrin/fibrinogen degradation product (FDP) and D-dimers. Unclottable blood and systemic bleeding were overcome in most patients 12 h after the antivenom therapy. Three patients developed systemic bleeding 48 h after antivenom therapy. Levels of fibrinogen and alpha 2-antiplasmin, FDP and D-dimer returned to normal around 48 h after the treatment or on discharge. The frequency of thrombocytopenia with high mean platelet volume increased in the first 24 h after antivenom therapy, and decreased on discharge. venom levels in patients decreased 12 h after antivenom therapy and were not correlated with coagulation and fibrinolytic parameters. There were no deaths. Laboratorial parameters of coagulopathy returned to normal values within 48 h after the antivenom therapy until discharge. A few patients still presented bleeding signs within 48 h after beginning antivenom therapy. However, the Brazilian antivenom was able to overcome the hemostatic disorders in these cases of envenomation.
蛇伤是亚马逊地区的一个主要公共卫生问题，也会导致止血障碍。在这项研究中，我们评估了给予抗蛇毒血清治疗后蛇伤患者止血障碍的恢复情况。这是一项前瞻性研究，纳入了 2016 年 1 月至 2017 年 12 月在巴西亚马逊州玛瑙斯接受治疗的 100 例蛇伤患者。在入院时、抗蛇毒血清治疗后 12、24 和 48 小时以及出院时采集血样，用于测量毒液浓度、血小板、凝血时间和患者的凝血因子。在随访期间记录是否有全身性出血。入院时，14%的患者存在全身性出血。10%的患者存在血小板减少症。共有 54%的患者表现为血液不凝，纤维蛋白原和α 2-抗纤溶酶水平降低，纤维蛋白（原）/纤维蛋白降解产物（FDP）和 D-二聚体水平升高。大多数患者在抗蛇毒血清治疗 12 小时后凝血功能恢复正常，3 例患者在抗蛇毒血清治疗 48 小时后出现全身性出血。纤维蛋白原和α 2-抗纤溶酶、FDP 和 D-二聚体在治疗后 48 小时或出院时恢复正常。抗蛇毒血清治疗后 24 小时内血小板减少症伴血小板平均体积升高的频率增加，出院时降低。患者的蛇毒水平在抗蛇毒血清治疗 12 小时后下降，与凝血和纤维蛋白溶解参数无关。无死亡病例。抗蛇毒血清治疗后 48 小时内凝血功能障碍的实验室参数恢复正常，直至出院。少数患者在开始抗蛇毒血清治疗后 48 小时内仍有出血迹象。然而，巴西抗蛇毒血清能够克服这些蛇伤患者的止血障碍。
