Department of Emergency Medicine, Banner-University Medical Center Phoenix, Phoenix, AZ, USA.
The University of Arizona College of Medicine-Phoenix, Phoenix, AZ, USA.
Clin Toxicol (Phila). 2022 Jul;60(7):838-842. doi: 10.1080/15563650.2022.2042550. Epub 2022 Mar 9.
Late hemotoxicity is common following rattlesnake envenomation treated with crotalidae immune polyvalent Fab (ovine) (FabAV). Initial clinical trials showed crotalidae immune F(ab')2 (equine) (Fab2AV) to be superior to FabAV in preventing late hemotoxicity, but this effect has not been demonstrated in broader populations. This study investigated late hemotoxicity in patients receiving Fab2AV or FabAV after rattlesnake envenomation.
This is a retrospective analysis of prospectively collected data from patients with snakebite reported to the ToxIC North American Snakebite Registry (NASBR) between January 1, 2019, and December 31, 2020. Inclusion criteria were rattlesnake envenomation and administration of antivenom. Patients were excluded if they received more than one type of antivenom. The primary outcome was occurrence of late hemotoxicity (platelets ≤120 k/mm or fibrinogen ≤170 mg/dL) in patients receiving Fab2AV and FabAV. Data collected included demographics, envenomation characteristics, laboratory values, and treatment administered. Statistics including -test and Fisher's exact test were used.
A total of 201 rattlesnake envenomated patients receiving antivenom were reported to the NASBR in the study period; 144 were included. 49 received Fab2AV alone, 45 received FabAV alone and 50 received both antivenoms. Baseline patient and envenomation characteristics were similar between the groups. Late hemotoxicity occurred in 2/49 patients in the Fab2AV group (4% (95% CI 0.7-12.6)) and in 19/45 patients in the FabAV group (42% (95% CI 28.4-59.0); absolute risk reduction 39.1% (95% CI 21.2-46.2) ( = 0.001). On follow up, 0 patients (0%) receiving Fab2AV were retreated with antivenom; 4 patients (9%) receiving FabAV were retreated ( = 0.049).
In the North American Snakebite Registry, late hemotoxicity was less common in rattlesnake envenomated patients treated with Fab2AV compared to FabAV.
接受响尾蛇抗毒血清（牛源多价 Fab 片段）治疗后，常见迟发性血液毒性。初步临床试验表明，与响尾蛇抗毒血清（牛源 Fab 片段）相比，响尾蛇抗毒血清 F(ab')2（马源）（Fab2AV）在预防迟发性血液毒性方面更具优势，但这一效果在更广泛的人群中尚未得到证实。本研究调查了响尾蛇咬伤后接受 Fab2AV 或 FabAV 治疗的患者的迟发性血液毒性。
这是一项回顾性分析，对 2019 年 1 月 1 日至 2020 年 12 月 31 日期间向北美蛇伤登记处（NASBR）报告的蛇咬伤患者的前瞻性收集数据进行分析。纳入标准为响尾蛇咬伤和使用抗蛇毒血清。如果患者接受了不止一种类型的抗蛇毒血清，则将其排除在外。主要结局是接受 Fab2AV 和 FabAV 治疗的患者出现迟发性血液毒性（血小板 ≤120 k/mm 或纤维蛋白原 ≤170 mg/dL）。收集的数据包括人口统计学特征、咬伤特征、实验室值和治疗方法。使用卡方检验和 Fisher 确切检验进行统计分析。
在研究期间，共有 201 例接受抗蛇毒血清治疗的响尾蛇咬伤患者向 NASBR 报告，其中 144 例被纳入分析。49 例患者单独接受 Fab2AV 治疗，45 例患者单独接受 FabAV 治疗，50 例患者同时接受两种抗蛇毒血清治疗。两组患者的基线特征相似。Fab2AV 组有 2/49 例（4%（95%CI 0.7-12.6））和 FabAV 组有 19/45 例（42%（95%CI 28.4-59.0））患者出现迟发性血液毒性，绝对风险降低 39.1%（95%CI 21.2-46.2）（ = 0.001）。随访期间，0 例（0%）接受 Fab2AV 治疗的患者需要再次接受抗蛇毒血清治疗；接受 FabAV 治疗的患者中有 4 例（9%）需要再次治疗（ = 0.049）。
在北美蛇伤登记处，与接受 FabAV 治疗的患者相比，接受 Fab2AV 治疗的响尾蛇咬伤患者的迟发性血液毒性更少见。
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