• G K Isbister, S B Duffull, S G A Brown, and ASP Investigators.
• Tropical Toxinology Unit, Menzies School of Health Research, Charles Darwin University, Darwin, Australia. geoffrey.isbister@menzies.edu.au
• QJM. 2009 Aug 1;102(8):563-8.

BackgroundVenom-induced consumption coagulopathy (VICC) is an important feature of snake envenoming.AimTo investigate the effect of antivenom and fresh frozen plasma (FFP) on recovery of VICC in Australian elapid snake envenoming.DesignProspective cohort study.MethodsPatients with VICC were included from the Australian Snakebite Project (ASP). Time to recovery of VICC (defined as time until INR <2) was investigated using a time to event analysis in WinBUGS. The model considered the effects of age, sex, snake type, time of antivenom after bite, antivenom dose and use of FFP within 4 h.ResultsThe study included 167 cases of VICC, median age being 41 [interquartile range (IQR): 28-53) years, and 130 (78%) were males. Antivenom was administered at a median of 3.6 (IQR: 2.2-5.6) h after the bite at a median dose of four vials (IQR: 2-6 vials). Thirteen patients received FFP within 4 h. Recovery of VICC occurred after a median of 14.4 (IQR: 11.5-17.5) h, and only the use of FFP within 4 h influenced the time to recovery. Neither antivenom dose nor time of antivenom administration had an effect on recovery of VICC. In patients administered with FFP, 12% [credible interval (CrI): 6-21%] and 81% (CrI: 61-94%) had recovered at 6 and 12 h, respectively, vs 2.5% (CrI: 1.5-4%) and 28% (CrI: 22-34%) not receiving FFP.DiscussionAntivenom did not appear to be effective for the coagulopathy in snake envenoming in Australia. FFP appeared to shorten the time of VICC recovery.

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