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Efficacy of antivenom against the procoagulant effect of Australian brown snake (Pseudonaja sp.) venom: In vivo and in vitro studies

Isbister, Geoffrey K., O'Leary, Margaret A., Schneider, Jennifer J., Brown, Simon G.A. and Currie, Bart J. (2007). Efficacy of antivenom against the procoagulant effect of Australian brown snake (Pseudonaja sp.) venom: In vivo and in vitro studies. Toxicon,49(1):57-67.

Document type: Journal Article
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IRMA ID s994677xPUB183
Title Efficacy of antivenom against the procoagulant effect of Australian brown snake (Pseudonaja sp.) venom: In vivo and in vitro studies
Author Isbister, Geoffrey K.
O'Leary, Margaret A.
Schneider, Jennifer J.
Brown, Simon G.A.
Currie, Bart J.
Journal Name Toxicon
Publication Date 2007
Volume Number 49
Issue Number 1
ISSN 0041-0101   (check CDU catalogue open catalogue search in new window)
Start Page 57
End Page 67
Total Pages 11
Place of Publication United Kingdom
Publisher Pergamon
Field of Research 1115 - Pharmacology and Pharmaceutical Sciences
HERDC Category C1 - Journal Article (DEST)
Abstract Snake venom induced consumption coagulopathy (VICC) is a common complication of snake bite due to prothrombin activators or thrombin-like enzymes in the venom. This study aimed to determine the efficacy and dose of antivenom for treating VICC in patients envenomed by brown snakes (Pseudonaja spp.), including in vitro coagulation studies. In serial blood samples from patients with brown snake envenoming, venom and antivenom concentrations were measured using enzyme immunoassays. In Vitro mixtures of brown snake venom and antivenom were used to investigate antivenom binding, neutralisation of prothrombin activity, prevention of venom-mediated clotting and effect on thrombin generation parameters using a thrombinoscope. In 27 envenomed patients the median venom concentration was 20ng/mL (Interquartile range[IQR]:12-44ng/mL) prior to antivenom and was not detected after antivenom administration, including 9 patients given one vial. In vitro, 200 mu g/mL of antivenom bound all free venom at venom concentrations seen in patients. In vitro prothrombinase activity of the venom (using a chromogenic substrate) was not neutralised by antivenom. However, for venom concentrations seen in humans, 100 mu g/mL of antivenom prevented venom clotting activity in human plasma and 479 mu g/mL neutralised procoagulant venom activity measured by triggering thrombin generation. One vial of antivenom appears to be sufficient to bind and neutralise all venom in patients with severe brown snake envenoming. (c) 2006 Elsevier Ltd. All rights reserved.
Keywords Pseudonaja sp
snake envenoming
antivenom
procoagulant
brown snake
coagulopathy
DOI http://dx.doi.org/10.1016/j.toxicon.2006.09.007   (check subscription with CDU E-Gateway service for CDU Staff and Students  check subscription with CDU E-Gateway in new window)
 
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