Coagulopathy After Viper Snakebite in Vietnam and Relationship with Time of Admission

Xuan Thi Dang,1,2 Thanh Xuan Nguyen,3– 5 Thu Thi Hoai Nguyen,3,4 Hung Tran Ha1,2 1Vietnam Poison Control Center, Bach Mai Hospital, Hanoi, 100000, Vietnam; 2Department of Emergency and Critical Care Medicine, Hanoi Medical University, Hanoi, 100000, Vietnam; 3Geriatrics Department, Hanoi Medical University, Hanoi, 100000, Vietnam; 4Scientific Research Department, National Geriatric Hospital, Hanoi, 100000, Vietnam; 5Dinh Tien Hoang Institute of Medicine, Hanoi, 100000, VietnamCorrespondence: Xuan Thi DangVietnam Poison Control Center, Bach Mai Hospital, Hanoi, 100000, VietnamTel +84 912260366Email xuandangthi@bachmai.edu.vnBackground: Snakebite envenoming is a potentially life-threatening condition and causes many serious consequences.Subjects and Methods: Therefore, this study aimed to throw some light on coagulopathy after Viperidae envenomations at Vietnam Poison Control Center and the relationship between coagulopathy and time of admission. A prospective, descriptive study was conducted from October 2016 to April 2018. The survey questionnaire included socio-economic characteristics, characteristics of snakebite, signs and clinical symptoms and blood test. Disseminated intravascular coagulation (DIC) condition was diagnosed using the International Society on Thrombosis and Haemostasis (ISTH) criteria. Rotational thromboelastometry was evaluated using ROTEM® delta system.Results: A total of 41 cases of viper snakebite with the mean age of snakebite victims were 41.27 ± 14.72 years old. Mean hospital stay of the patients was 5.63± 3.29 days. The association between coagulation disorder and clotting time (CT) EXTEM prolonged, CT INTEM prolonged, CT FIBTEM prolonged remained significant (multivariable odds ratio MOR=5.81, 95% CI: 1.20– 28.06; MOR= 9.32, 95% CI: 1.001– 84.48; MOR=5.55, 95% CI: 1.12– 27.50, respectively).Conclusion: This study indicates a hypocoagulation status in ROTEM, elevated international normalised ratio (INR), activated partial thromboplastin time (APTT) and D-dimer, decreased fibrinogen concentration and platelet count following envenoming by Viperidae.Keywords: viper, snakebite, Vietnam, coagulopathy, ROTEM