Persistence of venom-induced consumption coagulopathy (VICC) associated with the late application of antivenom after snakebite by Bothrops complex: a retrospective cohort study

IntroductionAntivenom neutralizes the effects of snake venom toxins. Its timely administration can by critical in reducing the risk of complications, including serious clinical hemorrhage. The objective of this study was to evaluate the relationship between the late administration of antivenom and the persistence of venom-induced consumption coagulopathy (VICC) in patients with Bothrops snakebite envenomation. MethodsWe conducted a retrospective observational study in three hospitals referent in the management of snakebite envenomation in a region of Colombia. Patients were identified through ICD10 codes. The information was extracted from patients clinical records. Late and early antivenom administration patients were compared; "late" was defined as a period between snakebite and antivenom administration >4h. Definition of persistence of VICC was as an International Normalized Ratio >1.5 between 25-72h after snakebite. The clinical bleeding (as reported by clinicians) was also explored. Groups were compared through X2 of association; binary and multiple logistic regressions were ran to estimate the magnitude of the crude and adjusted relative risk (RR) for the analyzed outcomes. Results304 patients with snakebite from Bothrops spp.were analyzed; 138 (45.3%) with late antivenom administration, and 166 (54.7%) early. The persistence of VICC was more frequent in the late antivenom group (2.06 [95% IC 1.11-3.83]), as well as for clinical bleeding and major bleeding (1.97[1.30-2.98]; 3.00 [1.19-7.54], respectively). DiscussionLate antivenom administration was associated with increased risk in the persistence of VICC and major bleeding in patients with envenomation by a Bothrops complex snakebite. The results reported in the literature are diverse; inter and intra species variability and definitions can influence the finding. ConclusionsThe Timely administration of antivenom was associated with an increased risk in persistence of VICC. SynopsisSnakebites can cause different levels of damage to humans, depending on the type of venom. The venom produced by pit vipers, specifically those of the genus Bothrops, can change blood clotting and cause bleeding that can be life-threatening. Most snakebites from these vipers occur in tropical areas where the most affected are farmers and rural people. There is often a lack of access to antivenom treatment, depending on access to and provision of health services. It seems that giving the antivenom at the right time can reduce the risk of complications. However, it is still unclear whether waiting to give the antivenom increases the risk of continued envenoming and bleeding. This study shows that waiting to treat a patient can lead to a higher chance of bleeding. This information can help doctors, decision makers, and lawmakers improve treatment options and access in remote areas.