Current treatment for venom-induced consumption coagulopathy resulting from snakebite.
Current treatment for venom-induced consumption coagulopathy resulting from snakebite.
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DOI：
10.1371/journal.pntd.0003220
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发表时间：
2014-10
影响因子：
3.8
通讯作者：
Isbister GK
中科院分区：
文献类型：
--
作者：
Maduwage K;Isbister GK
毒蛇咬伤被认为是世界范围内有毒动物造成人类伤害的唯一最重要原因。凝血障碍是最常见的重要的全身性临床综合征之一，可并发严重和危及生命的出血。毒液诱发的消耗性凝血病（Venom-induced consumption coagulopathy，VICC）是蛇咬伤引起的最常见的凝血病，发生在蝰蛇科蛇、某些眼镜蛇（包括澳大利亚眼镜蛇）和一些游蛇（后牙）的毒液中毒中。促凝血毒素激活凝血途径，根据蛇毒中特定的促凝血毒素引起广泛的因子缺乏。凝血障碍的诊断和监测是有问题的，特别是在资源贫乏的国家，需要进一步的研究来开发更可靠，更便宜的凝血试验。检索了截至2013年9月的MEDLINE和EMBASE，以识别VICC毒蛇中毒的临床研究。在UniPort数据库中检索凝血剂蛇毒素。尽管临床前研究证明了抗蛇毒血清结合毒素（有效性），但支持抗蛇毒血清对VICC临床有效性的证据较少。没有VICC抗蛇毒血清的安慰剂对照试验。有25项VICC抗蛇毒血清随机比较试验，比较了两种不同的抗蛇毒血清（10项研究），三种不同的抗蛇毒血清（4项），两种或三种不同剂量或重复剂量的抗蛇毒血清（5项），肝素治疗和抗蛇毒血清（5项），静脉注射免疫球蛋白治疗和抗蛇毒血清（1项）。有13项研究对两组进行了比较，其中没有随机化，包括具有历史对照的研究。有许多抗蛇毒血清在VICC中的观察性研究，但没有对照组。大多数对照试验规模较小，没有使用相同的方法评估凝血功能障碍，改变了抗蛇毒血清的剂量，也没有提供研究设计的完整细节（主要结局、随机化和分配隐藏）。包括没有抗蛇毒血清的对照组在内的非随机试验表明，抗蛇毒血清对某些蛇有效（例如，Echis），但不是其他（例如，澳大利亚眼镜蛇）。抗蛇毒血清是VICC的主要治疗方法，但目前几乎没有高质量的证据支持其有效性。抗蛇毒血清并非没有风险，不良反应可能相当常见，而且可能很严重。肝素的研究未证明其改善VICC的结局。新鲜冷冻血浆似乎可以加速凝血功能障碍的恢复，因此在出血患者中应予以考虑。
Venomous snakebite is considered the single most important cause of human injury from venomous animals worldwide. Coagulopathy is one of the commonest important systemic clinical syndromes and can be complicated by serious and life-threatening haemorrhage. Venom-induced consumption coagulopathy (VICC) is the commonest coagulopathy resulting from snakebite and occurs in envenoming by Viperid snakes, certain elapids, including Australian elapids, and a few Colubrid (rear fang) snakes. Procoagulant toxins activate the clotting pathway, causing a broad range of factor deficiencies depending on the particular procoagulant toxin in the snake venom. Diagnosis and monitoring of coagulopathy is problematic, particularly in resource-poor countries where further research is required to develop more reliable, cheap clotting tests. MEDLINE and EMBASE up to September 2013 were searched to identify clinical studies of snake envenoming with VICC. The UniPort database was searched for coagulant snake toxins. Despite preclinical studies demonstrating antivenom binding toxins (efficacy), there was less evidence to support clinical effectiveness of antivenom for VICC. There were no placebo-controlled trials of antivenom for VICC. There were 25 randomised comparative trials of antivenom for VICC, which compared two different antivenoms (ten studies), three different antivenoms (four), two or three different doses or repeat doses of antivenom (five), heparin treatment and antivenom (five), and intravenous immunoglobulin treatment and antivenom (one). There were 13 studies that compared two groups in which there was no randomisation, including studies with historical controls. There have been numerous observational studies of antivenom in VICC but with no comparison group. Most of the controlled trials were small, did not use the same method for assessing coagulopathy, varied the dose of antivenom, and did not provide complete details of the study design (primary outcomes, randomisation, and allocation concealment). Non-randomised trials including comparison groups without antivenom showed that antivenom was effective for some snakes (e.g., Echis), but not others (e.g., Australasian elapids). Antivenom is the major treatment for VICC, but there is currently little high-quality evidence to support effectiveness. Antivenom is not risk free, and adverse reactions can be quite common and potentially severe. Studies of heparin did not demonstrate it improved outcomes in VICC. Fresh frozen plasma appeared to speed the recovery of coagulopathy and should be considered in bleeding patients.
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DOI：
10.1016/s0035-9203(01)90339-6
发表时间：
2001-01-01
影响因子：
2.2
作者：
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影响因子：
3.3
作者：
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影响因子：
2.8
作者：
BARRANTES, A;SOLIS, V;BOLANOS, R
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BOLANOS, R
影响因子：
2.8
作者：
GILLISSEN, A;THEAKSTON, RDG;WARRELL, DA
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WARRELL, DA
影响因子：
2.8
作者：
HARDY, DL;JETER, M;CORRIGAN, JJ
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