Failure of a Mexican antivenom on recovery from snakebite-related coagulopathy in French Guiana

Abstract

Introduction

In French Guiana, most snakebites are caused by crotalids, with the main signs being tissue damage and bleeding due to venom-induced coagulopathy. Since December 2014 the Western Guiana Hospital (WGH) has used Antivipmyn Tri^TM, a Mexican polyvalent antivenom. The aim of the study was to assess its benefit on the correction of snakebite-related coagulopathy.

Methods

This retrospective study included patients hospitalized at the WGH with snakebite and a coagulopathy defined by: a prothrombin rate (PR) lower than 45%, an activated partial thromboplastin time ratio (aPTTr) greater than 2 or a fibrinogen lower than 100 mg.dL⁻¹. The antivenom group included patients receiving Antivipmyn Tri^TM from December 2014 to September 2017. The control group included patients admitted between January 2013 and November 2014 (when antivenom was unavailable) or admitted between December 2014 and September 2017 during times of antivenom shortage. We graphically compared the time courses of PR, aPTTr and fibrinogen between groups. Other endpoints were the length of hospital stay and the need for surgery or dialysis.

Results

84 patients were included: 42 in the antivenom group, 42 in the control group. Both groups were similar for age, sex-ratio, proportion of bleedings, necrosis, and severity. Most patients in the antivenom group received 3 vials. There were no significant differences in recovery of PR, aPTTr and fibrinogen through the first 24 h. Fibrinogen declined again in the control group at 30 h and showed a slower rise to normal concentration. There were no significant differences in any secondary endpoint.

Conclusion

Antivipmyn Tri^TM as currently used did not show any benefit in recovery from coagulopathy.

Keywords:

• Snakebite
• crotalinae
• immunotherapy
• French Guiana
• coagulopathy
• Bothrops atrox

Acknowledgments

The authors would like to thank Misses Avilon and Edwards, Doctors Kezza Crépin, Pousset François, Ntab Balthazar and Mr. Beneteau Samuel for their kind help and careful reading of the manuscript.

Disclosure statement

No potential conflict of interest was reported by the author(s).