Bothrops snakebites in the Amazon: recovery from hemostatic disorders after Brazilian antivenom therapy
Bothrops snakebites in the Amazon: recovery from hemostatic disorders after Brazilian antivenom therapy
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DOI：
10.1080/15563650.2019.1634273
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发表时间：
2019-07-01
影响因子：
3.3
通讯作者：
Monteiro, Wuelton Marcelo
中科院分区：
文献类型：
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作者：
de Oliveira, Samella Silva;Alves, Eliane Campos;Monteiro, Wuelton Marcelo
简介：Bothrops atrox蛇咬伤是亚马逊地区的一个主要公共卫生问题，也会导致止血障碍。在这项研究中，我们评估了Bothrops蛇咬伤患者在接受抗蛇毒血清治疗后止血障碍的恢复情况。研究方法：这是一项前瞻性研究，研究对象为2016年1月至2017年12月期间在巴西亚马逊马瑙斯Fundacao de Medicina Tropical Dr. Heitor Vieira Dourado治疗的Bothrops蛇咬伤患者（n = 100）。分别于入院时、抗蛇毒血清治疗后12、24、48 h及出院时采血，测定血清中蛇毒浓度、血小板、凝血时间及凝血因子。在随访期间记录全身出血的存在。结果：入院时，14%的患者出现全身出血。在10%的患者中观察到血小板减少。总共有54%的患者表现出低水平的纤维蛋白原和α 2-抗纤溶酶，以及高水平的纤维蛋白/纤维蛋白原降解产物（FDP）和D-二聚体的非闭合性血液。大部分患者在抗蛇毒血清治疗后12 h内未出现血凝块和全身出血。3例患者在抗蛇毒血清治疗后48 h发生全身出血。纤维蛋白原和α 2-抗纤溶酶、FDP和D-二聚体水平在治疗后约48小时或出院时恢复正常。在抗蛇毒血清治疗后的前24小时内，血小板减少伴高平均血小板体积的频率增加，出院时减少。抗蛇毒血清治疗后12小时，患者的Bothrops毒液水平下降，与凝血和纤溶参数无关。无死亡病例。结论：抗蛇毒血清治疗后48 h内凝血功能恢复正常。少数患者在开始抗蛇毒血清治疗后48 h内仍出现出血体征。然而，巴西抗蛇毒血清能够克服这些毒液蛰入病例中的止血障碍。
Introduction: Bothrops atrox snakebites are a major public health problem in the Amazon region and also cause hemostatic disorders. In this study, we assessed the recovery from hemostatic disorders in Bothrops snakebite patients after being given antivenom therapy. Methods: This is a prospective study of Bothrops snakebite patients (n = 100) treated at the Fundacao de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus, Brazilian Amazon, between January 2016 and December 2017. Blood samples were taken for the measurement of venom concentrations, platelets, clotting time and factors of patients on admission, 12, 24 and 48 h after antivenom therapy, and taken again on discharge. The presence of systemic bleeding was recorded during the follow-up. Results: On admission, systemic bleeding was observed in 14% of the patients. Thrombocytopenia was noted in 10% of the patients. A total of 54% of the patients presented unclottable blood with low levels of fibrinogen and alpha 2-antiplasmin, and high levels of fibrin/fibrinogen degradation product (FDP) and D-dimers. Unclottable blood and systemic bleeding were overcome in most patients 12 h after the antivenom therapy. Three patients developed systemic bleeding 48 h after antivenom therapy. Levels of fibrinogen and alpha 2-antiplasmin, FDP and D-dimer returned to normal around 48 h after the treatment or on discharge. The frequency of thrombocytopenia with high mean platelet volume increased in the first 24 h after antivenom therapy, and decreased on discharge. Bothrops venom levels in patients decreased 12 h after antivenom therapy and were not correlated with coagulation and fibrinolytic parameters. There were no deaths. Conclusion: Laboratorial parameters of coagulopathy returned to normal values within 48 h after the antivenom therapy until discharge. A few patients still presented bleeding signs within 48 h after beginning antivenom therapy. However, the Brazilian antivenom was able to overcome the hemostatic disorders in these cases of envenomation.