Assesment of Coagulopathy in Patients with Systemic Bleeding due to Snake Bite-Correlation with the Dose of Anti Snake Venom

Even though snakebite associated coagulopathy is a common cause of mortality and morbidity in India, the severity assessment and management protocols are poorly defined. Our study aims at identifying-

a) Clinical spectrum of bleeding

B) Hematological markers of severe coagulopathy

C) Optimize the dose of Anti Snake Venom (ASV) in patients with severe coagulopathy

Case records of 59 patients with systemic bleeding following snakebite were studied and their clinical presentation and coagulation parameters were noted. They were grouped depending on total ASV received: <100ml-group A & >100ml-group B. Statistical analysis was done to find out correlation between different coagulation parameters with the total dose of ASV required at endpoint in each group.

Patients in Group-B had severe coagulopathy featured by significantly prolonged CT, and APTT (p<0.05); prolonged PT and low fibrinogen (p <0.01). All these tests have shown strong association with mean higher doses of ASV. Group-B patients presented much later and the mean doses of ASV required in groups A and B were 81.48 ±21.6 ml and 206 ± 73 ml respectively.

A combination of PT and fibrinogen correlated well with severety of coagulopathy in patients with systemic bleeding due to snake bite. These patients may require upto 206 ± 73 ml of ASV. Patients with delayed presentation had more severe coagulopathy and required higher doses of ASV.