Abstract

Pit viper venom commonly causes venom-induced consumptive coagulopathy (VICC), which can be complicated by life-threatening hemorrhage. VICC has a complex pathophysiology affecting multiple steps of the coagulation pathway. Early detection of VICC is challenging because conventional blood tests such as prothrombin time (PT) and activated partial thromboplastin time (aPTT) are unreliable for early-stage monitoring of VICC progress. As the effects on the coagulation cascade may differ, even in the same species, the traditional coagulation pathways cannot fully explain the mechanisms involved in VICC or may be too slow to have any clinical utility. Antivenom should be promptly administered to neutralize the lethal toxins, although its efficacy remains controversial. Transfusion, including fresh frozen plasma, cryoprecipitate, and specific clotting factors, has also been performed in patients with bleeding. The effectiveness of viscoelastic monitoring in the treatment of VICC remains poorly understood. The development of VICC can be clarified using thromboelastography (TEG), which shows the procoagulant and anticoagulant effects of snake venom. Therefore, we believe that TEG may be able to be used to guide hemostatic resuscitation in victims of VICC. Here, we aim to discuss the advantages of TEG by comparing it with traditional coagulation tests and propose potential treatment options for VICC.

Highlights

  • Pit vipers inhabit Asia, North America, Europe, and Africa [1]

  • We aim to discuss the advantages of thromboelastography (TEG) by comparing it with traditional coagulation tests to identify the potential treatments for venom-induced consumptive coagulopathy (VICC)

  • Of the systemic symptoms associated with envenomation, coagulopathy induced by pit viper venom has unique characteristics [2]

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Summary

Introduction

Pit vipers inhabit Asia, North America, Europe, and Africa [1]. Envenomation through a pit viper bite is frequently reported, and it can lead to critical illnesses [1,2]. Venom-induced consumption coagulopathy (VICC) is a central issue following a pit viper bite because it can be lethal [2]. It is currently difficult to characterize coagulopathy and identify specific treatment because of the complex pathophysiology of coagulopathy following a pit viper bite [1]. Thromboelastographic analysis of hemostasis has been performed to elucidate the pathophysiology of coagulopathy in patients after a pit viper bite [3,4,5,6,7,8]. We aim to discuss the advantages of thromboelastography (TEG) by comparing it with traditional coagulation tests to identify the potential treatments for VICC

Characteristics of Envenomation by a Pit Viper
Pathophysiology of VICC
Clinical Manifestation of VICC
Limitations of Traditional Coagulation Tests
Thromboelastography
Immunological Test
Antivenom
Transfusion
Conclusions
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