Valenta J, Stach Z, Porizka M, Michalek P
Bratisl Lek Listy. 2019;120(8):566-568. doi: 10.4149/BLL_2019_092.
Viperidae snakes are responsible for 95 % of the bites caused by exotic-bred snakes in our country. Their envenoming may be associated with a severe acute coagulation disorder - venom-induced consumption coagulopathy (VICC). Thus, its early prediction is vital for an adequate therapy including antivenom delivery.
Laboratory coagulation tests of 14 patients suffering from VICC were processed and statistically analyzed to evaluate the importance of individual parameters in the time after the bite.
The pathological values of D-dimer (D-dim) and fibrinogen (FBG) were found to be the first indicators of VICC development, with a median time of 4.55 hours since the bite, while median values for prothrombin time and international normalized ratio (PT/INR), activated partial thromboplastin time (APTT), and thrombin time (TT) were 5.9 h, 8.15 h, and 5.5 h, respectively. In the first samples, the values of D-dim were found to be pathologically increased in all 14 patients, while pathological levels of FBG were seen only in 11 cases. PT/INR and APTT were prolonged in 8 and 6 cases, respectively.
An increase in D-dim values was found to be the first parameter signaling developing VICC in all analyzed cases (Tab. 2, Ref. 12).
蝰蛇科蛇类导致了我国95%的外来养殖蛇咬伤事件。它们的毒液可能与一种严重的急性凝血障碍——毒液诱导的消耗性凝血病（VICC）相关。因此，其早期预测对于包括注射抗蛇毒血清在内的适当治疗至关重要。
对14例VICC患者进行实验室凝血试验并进行统计分析，以评估咬伤后不同时间各参数的重要性。
发现D-二聚体（D-dim）和纤维蛋白原（FBG）的病理值是VICC发生的首要指标，咬伤后中位数时间为4.55小时，而凝血酶原时间和国际标准化比值（PT/INR）、活化部分凝血活酶时间（APTT）以及凝血酶时间（TT）的中位数分别为5.9小时、8.15小时和5.5小时。在首次采集的样本中，14例患者的D-dim值均出现病理性升高，而仅11例患者的FBG水平呈病理性升高。PT/INR和APTT分别在8例和6例患者中延长。
在所有分析病例中，发现D-dim值升高是VICC发生的首个信号参数（表2，参考文献12）。
