• Kacey M O'Rourke, Elizabeth Correlje, Cameron L Martin, Jeremy D Robertson, and Geoffrey K Isbister.
• Department of Haematology, Pathology Queensland Central Laboratory, Brisbane, Queensland, Australia.
• Thromb. Res. 2013 Nov 1;132(5):610-3.

IntroductionPoint-of-care international normalised ratio (INR) has been suggested as a way to screen for venom-induced consumption coagulopathy following snakebite, but has not been validated for this. This study aimed to assess the diagnostic reliability of point-of-care INR for venom-induced consumption coagulopathy.MethodsThis was a prospective study of snakebite patients recruited between January 2011 and May 2012 where a point-of-care INR was done and compared to an INR done on a laboratory coagulation analyser, as part of a quality assurance exercise. Data was obtained for each patient, including demographics, information on the snake bite, the point-of-care INR results and any laboratory derived coagulation studies. Snake identification was confirmed by expert identification or venom specific enzyme immunoassay.ResultsThere were 15 patients with a median age of 29 years (2 to 68 y) and 13 were male. Four of the 7 patients with venom-induced consumption coagulopathy had an abnormal point-of-care INR (3 false negatives) and 1 of the 7 non-envenomed patients had an abnormal point-of-care INR (1 false positive). The patient with a falsely elevated point-of-care INR was given antivenom prior to formal coagulation studies. The point-of-care INR was also negative in the patient with an anticoagulant coagulopathy.ConclusionsThe study shows that point-of-care INR testing devices should not be used in suspected snakebite cases in Australia to diagnose venom-induced consumption coagulopathy.© 2013.

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