Thom S Maciulewicz, David R Axon, Farshad Mazda Shirazi
{"title":"响尾蛇中毒后使用巴豆科免疫 F(ab')2（马）抗蛇毒血清治疗的低纤维蛋白原血症的特征。","authors":"Thom S Maciulewicz, David R Axon, Farshad Mazda Shirazi","doi":"10.1080/15563650.2024.2406427","DOIUrl":null,"url":null,"abstract":"<p><strong>Introduction: </strong>Hemotoxicity is common following rattlesnake envenomation. Published experiences with equine-derived crotalidae immune F(ab')<sub>2</sub> antivenom have characterized hemotoxicity as delayed, recurrent, or persistent. This study investigated recovery of hypofibrinogenemia following rattlesnake envenomation treated with equine-derived crotalidae immune F(ab')<sub>2</sub> antivenom.</p><p><strong>Methods: </strong>This is a retrospective analysis of human rattlesnake envenomations reported to the Arizona Poison and Drug Information Center over four years. We included rattlesnake-envenomated patients who developed hypofibrinogenemia (<1,500 mg/L) and were treated with equine-derived crotalidae immune F(ab')<sub>2</sub> antivenom. The primary outcomes were recovery period (h) and recovery rate (mg/L/h) of hypofibrinogenemia following equine-derived crotalidae immune F(ab')<sub>2</sub> antivenom administration. Collected data included demographics, laboratory values, and antivenom administered. Statistics used were percentages, medians, and Kruskall-Wallis test.</p><p><strong>Results: </strong>There were 527 rattlesnake envenomations treated with antivenom, of which 80 met the inclusion criteria. Patients receiving treatment with F(ab')<sub>2</sub> antivenom and had a median fibrinogen concentration recovery rate of 62.3 mg/L/h (IQR: 42.0-74.3 mg/L/h) and median recovery period of 19.2 h (IQR: 13.8-26.2 h). There were statistically significant differences between categories for time to antivenom for the median recovery period (<i>P</i> = 0.0154).</p><p><strong>Discussion: </strong>Hypofibrinogenemia is a common laboratory finding following rattlesnake envenomation in Arizona. This study investigated rattlesnake envenomated patients treated with F(ab')<sub>2</sub> antivenom and monitored fibrinogen concentrations as a surrogate marker of venom toxicity. Additionally, time to administration of F(ab')<sub>2</sub> antivenom was a statistical significant marker of the recovery period from hypofibrinogenemia. Limitations of this study included the geographic coverage of the poison center and exclusion of patients with insufficient laboratory monitoring or those who received another antivenom.</p><p><strong>Conclusions: </strong>Following rattlesnake envenomation in Arizona, recovery from hypofibrinogenemia was able characterized in a rate (mg/L/h) and period (h) with the quantity and time to administration of antivenom. More studies are needed to assess this finding with other antivenoms and its clinical significance.</p>","PeriodicalId":10430,"journal":{"name":"Clinical Toxicology","volume":" ","pages":"749-753"},"PeriodicalIF":3.0000,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Characterization of hypofibrinogenemia following rattlesnake envenomation treated with crotalidae immune F(ab')<sub>2</sub> (equine) antivenom.\",\"authors\":\"Thom S Maciulewicz, David R Axon, Farshad Mazda Shirazi\",\"doi\":\"10.1080/15563650.2024.2406427\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Introduction: </strong>Hemotoxicity is common following rattlesnake envenomation. Published experiences with equine-derived crotalidae immune F(ab')<sub>2</sub> antivenom have characterized hemotoxicity as delayed, recurrent, or persistent. This study investigated recovery of hypofibrinogenemia following rattlesnake envenomation treated with equine-derived crotalidae immune F(ab')<sub>2</sub> antivenom.</p><p><strong>Methods: </strong>This is a retrospective analysis of human rattlesnake envenomations reported to the Arizona Poison and Drug Information Center over four years. We included rattlesnake-envenomated patients who developed hypofibrinogenemia (<1,500 mg/L) and were treated with equine-derived crotalidae immune F(ab')<sub>2</sub> antivenom. The primary outcomes were recovery period (h) and recovery rate (mg/L/h) of hypofibrinogenemia following equine-derived crotalidae immune F(ab')<sub>2</sub> antivenom administration. Collected data included demographics, laboratory values, and antivenom administered. Statistics used were percentages, medians, and Kruskall-Wallis test.</p><p><strong>Results: </strong>There were 527 rattlesnake envenomations treated with antivenom, of which 80 met the inclusion criteria. Patients receiving treatment with F(ab')<sub>2</sub> antivenom and had a median fibrinogen concentration recovery rate of 62.3 mg/L/h (IQR: 42.0-74.3 mg/L/h) and median recovery period of 19.2 h (IQR: 13.8-26.2 h). There were statistically significant differences between categories for time to antivenom for the median recovery period (<i>P</i> = 0.0154).</p><p><strong>Discussion: </strong>Hypofibrinogenemia is a common laboratory finding following rattlesnake envenomation in Arizona. This study investigated rattlesnake envenomated patients treated with F(ab')<sub>2</sub> antivenom and monitored fibrinogen concentrations as a surrogate marker of venom toxicity. Additionally, time to administration of F(ab')<sub>2</sub> antivenom was a statistical significant marker of the recovery period from hypofibrinogenemia. Limitations of this study included the geographic coverage of the poison center and exclusion of patients with insufficient laboratory monitoring or those who received another antivenom.</p><p><strong>Conclusions: </strong>Following rattlesnake envenomation in Arizona, recovery from hypofibrinogenemia was able characterized in a rate (mg/L/h) and period (h) with the quantity and time to administration of antivenom. More studies are needed to assess this finding with other antivenoms and its clinical significance.</p>\",\"PeriodicalId\":10430,\"journal\":{\"name\":\"Clinical Toxicology\",\"volume\":\" \",\"pages\":\"749-753\"},\"PeriodicalIF\":3.0000,\"publicationDate\":\"2024-11-01\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Clinical Toxicology\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.1080/15563650.2024.2406427\",\"RegionNum\":3,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"2024/9/25 0:00:00\",\"PubModel\":\"Epub\",\"JCR\":\"Q2\",\"JCRName\":\"TOXICOLOGY\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Clinical Toxicology","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1080/15563650.2024.2406427","RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"2024/9/25 0:00:00","PubModel":"Epub","JCR":"Q2","JCRName":"TOXICOLOGY","Score":null,"Total":0}
Characterization of hypofibrinogenemia following rattlesnake envenomation treated with crotalidae immune F(ab')2 (equine) antivenom.
Introduction: Hemotoxicity is common following rattlesnake envenomation. Published experiences with equine-derived crotalidae immune F(ab')2 antivenom have characterized hemotoxicity as delayed, recurrent, or persistent. This study investigated recovery of hypofibrinogenemia following rattlesnake envenomation treated with equine-derived crotalidae immune F(ab')2 antivenom.
Methods: This is a retrospective analysis of human rattlesnake envenomations reported to the Arizona Poison and Drug Information Center over four years. We included rattlesnake-envenomated patients who developed hypofibrinogenemia (<1,500 mg/L) and were treated with equine-derived crotalidae immune F(ab')2 antivenom. The primary outcomes were recovery period (h) and recovery rate (mg/L/h) of hypofibrinogenemia following equine-derived crotalidae immune F(ab')2 antivenom administration. Collected data included demographics, laboratory values, and antivenom administered. Statistics used were percentages, medians, and Kruskall-Wallis test.
Results: There were 527 rattlesnake envenomations treated with antivenom, of which 80 met the inclusion criteria. Patients receiving treatment with F(ab')2 antivenom and had a median fibrinogen concentration recovery rate of 62.3 mg/L/h (IQR: 42.0-74.3 mg/L/h) and median recovery period of 19.2 h (IQR: 13.8-26.2 h). There were statistically significant differences between categories for time to antivenom for the median recovery period (P = 0.0154).
Discussion: Hypofibrinogenemia is a common laboratory finding following rattlesnake envenomation in Arizona. This study investigated rattlesnake envenomated patients treated with F(ab')2 antivenom and monitored fibrinogen concentrations as a surrogate marker of venom toxicity. Additionally, time to administration of F(ab')2 antivenom was a statistical significant marker of the recovery period from hypofibrinogenemia. Limitations of this study included the geographic coverage of the poison center and exclusion of patients with insufficient laboratory monitoring or those who received another antivenom.
Conclusions: Following rattlesnake envenomation in Arizona, recovery from hypofibrinogenemia was able characterized in a rate (mg/L/h) and period (h) with the quantity and time to administration of antivenom. More studies are needed to assess this finding with other antivenoms and its clinical significance.
期刊介绍：
clinical Toxicology publishes peer-reviewed scientific research and clinical advances in clinical toxicology. The journal reflects the professional concerns and best scientific judgment of its sponsors, the American Academy of Clinical Toxicology, the European Association of Poisons Centres and Clinical Toxicologists, the American Association of Poison Control Centers and the Asia Pacific Association of Medical Toxicology and, as such, is the leading international journal in the specialty.
求助内容：
应助结果提醒方式：
京公网安备 11010802042870号
