1
|
Lajoye Q, Bouaoud M, Le Roux G, Weinmann L, Labadie M, Larréché S. Paraspecificity of Mexican antivipmyn TRI antivenom in envenomation by Chinese Protobothrops mangshanensis (Mangshan pit viper) in France: A case report and experimental neutralization of venom procoagulant effect. Toxicon 2024; 247:107826. [PMID: 38909759 DOI: 10.1016/j.toxicon.2024.107826] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2024] [Revised: 06/18/2024] [Accepted: 06/19/2024] [Indexed: 06/25/2024]
Abstract
This case report presents an exotic envenomation by a Chinese snake, Protobothrops mangshanensis. Its venom exhibited potent activity against plasma and fibrinogen, among other enzymatic activities. The patient initially presented with edema of the right upper limb, without tissue necrosis. There were no signs of bleeding; however, severe hypofibrinogenemia was observed (nadir value at 0.4 g/L), with a marked increase in fibrinogen degradation products and D-dimers, without any other coagulation disturbances. In the absence of a specific antivenom available against Asian Crotalinae venoms, the patient was treated at the 29th hour after bite with six vials of Antivipmyn™ TRI (Instituto Bioclon, Mexico, Mexico), a Mexican antivenom initially intended for American Crotalinae venoms, i.e., Bothrops asper, Lachesis muta and Crotalus durissus. Fibrinogen began to rise 6 hours after the antivenom infusion and was within the normal range 38 hours later. The report also underscores the utility of ClotPro® (Haemonetics ®USA), a viscoelastic test, for real-time monitoring of the snakebite-related coagulopathy. The clotting time was extended to 188 seconds on the EX-test while the MCF was decreased to 31 mm on the EX-test and the AP-test and was not measurable on the FIB-test, confirming severe hypofibrinogenemia. In order to confirm the paraspecificity of antivenom on the venom of P. mangshanensis, we studied the experimental neutralization of the venom procoagulant effect by Antivipmyn TRI and Green Pit Viper antivenom, which has been used in previous published clinical cases of P. mangshanensis envenomation. Both Antivipmyn™ TRI and Green Pit Viper antivenom corrected the procoagulant effect induced by P. mangshanensis venom. These findings suggest that Antivipmyn™ TRI cross-reacts with Protobothrops mangshanensis venom. In the absence of antivenom covering Asian Crotalinae, Antivipmyn TRI should be considered to treat an envenomation by Protobothrops spp.
Collapse
Affiliation(s)
- Quentin Lajoye
- Service de Réanimation Médicale, Centre Hospitalo-Universitaire de Bordeaux, Hôpital Pellegrin, Place Amélie Raba-Léon, 33000, Bordeaux, France.
| | - Misylias Bouaoud
- Service de Réanimation Médicale, Centre Hospitalo-Universitaire de Bordeaux, Hôpital Pellegrin, Place Amélie Raba-Léon, 33000, Bordeaux, France.
| | - Gaël Le Roux
- Centre Antipoison et Toxicovigilance Grand Ouest, Centre Hospitalo-Universitaire d'Angers, 4 rue Larrey 49 933, Angers, France.
| | - Laurent Weinmann
- Service d'hématologie Biologique, Centre Hospitalo-Universitaire de Bordeaux, Hôpital Haut-Lévêque, 1 Avenue Magellan, 33604, PESSAC, France.
| | - Magali Labadie
- Centre Antipoison et de Toxicovigilance De Nouvelle Aquitaine, Centre Hospitalo-Universitaire de Bordeaux, Hôpital Pellegrin, Place Amélie Raba-Léon, 33000, Bordeaux, France.
| | - Sébastien Larréché
- Département de Biologie Médicale, Hôpital d'instruction des Armées Bégin, 69 Avenue de Paris, 94160, Saint-Mandé, France, UMR-S1144, Université Paris Cité, 4 Avenue de l'observatoire, 75006, Paris, France.
| |
Collapse
|
2
|
Anderson TN, Farrell DH, Rowell SE. Fibrinolysis in Traumatic Brain Injury: Diagnosis, Management, and Clinical Considerations. Semin Thromb Hemost 2021; 47:527-537. [PMID: 33878779 DOI: 10.1055/s-0041-1722970] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Posttraumatic coagulopathy involves disruption of both the coagulation and fibrinolytic pathways secondary to tissue damage, hypotension, and inflammatory upregulation. This phenomenon contributes to delayed complications after traumatic brain injury (TBI), including intracranial hemorrhage progression and systemic disseminated intravascular coagulopathy. Development of an early hyperfibrinolytic state may result in uncontrolled bleeding and is associated with increased mortality in patients with TBI. Although fibrinolytic assays are not routinely performed in the assessment of posttraumatic coagulopathy, circulating biomarkers such as D-dimer and fibrin degradation products have demonstrated potential utility in outcome prediction. Unfortunately, the relatively delayed nature of these tests limits their clinical utility. In contrast, viscoelastic tests are able to provide a rapid global assessment of coagulopathy, although their ability to reliably identify disruptions in the fibrinolytic cascade remains unclear. Limited evidence supports the use of hypertonic saline, cryoprecipitate, and plasma to correct fibrinolytic disruption; however, some studies suggest more harm than benefit. Recently, early use of tranexamic acid in patients with TBI and confirmed hyperfibrinolysis has been proposed as a strategy to further improve clinical outcomes. Moving forward, further delineation of TBI phenotypes and the clinical implications of fibrinolysis based on phenotypic variation is needed. In this review, we summarize the clinical aspects of fibrinolysis in TBI, including diagnosis, treatment, and clinical correlates, with identification of targeted areas for future research efforts.
Collapse
Affiliation(s)
- Taylor N Anderson
- School of Medicine, Division of Trauma, Critical Care and Acute Care Surgery, Oregon Health and Science University, Portland, Oregon
| | - David H Farrell
- School of Medicine, Division of Trauma, Critical Care and Acute Care Surgery, Oregon Health and Science University, Portland, Oregon
| | - Susan E Rowell
- Department of Surgery, Duke University Medical Center, Durham, North Carolina
| |
Collapse
|
3
|
Trinh TH, Pao LP, Pivalizza EG. Thrombelastograph Platelet Mapping During Hyperfibrinolysis. J Cardiothorac Vasc Anesth 2020; 34:1708-1710. [PMID: 31917076 DOI: 10.1053/j.jvca.2019.12.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2019] [Revised: 12/03/2019] [Accepted: 12/07/2019] [Indexed: 11/11/2022]
|