Rattlesnake venom-induced recurrent coagulopathy in first trimester pregnant women – Two Cases. (May 2019)

• Record Type: Journal Article
• Authors: Moore, Elizabeth C.; Porter, Lauren M.; Ruha, Anne-Michelle
• Is Part Of: Toxicon. Volume 163(2019)
• Page Start: 8
• Page End: 11
• Publication Date: 2019-05
• Subjects: Antivenom -- Rattlesnake -- Pregnancy -- Coagulopathy -- Envenomation -- Hemorrhage; Toxins -- Periodicals; Venom -- Periodicals; 615.9
• DOI: 10.1016/j.toxicon.2019.03.006
• Languages: English
• ISSNs: 0041-0101

Abstract

Abstract: Delayed or recurrent coagulopathy can occur up to 14 days after North American rattlesnake envenomation in patients that have been treated with Crotalidae Polyvalent Immune Fab (CroFab). There is little data in the literature characterizing the sequelae of North American rattlesnake envenomation in pregnancy and no previously published reports of recurrent coagulopathy in pregnancy. Case report: We present 2 cases of first trimester pregnant women requiring readmission and retreatment with Crotalidae Polyvalent Immune Fab (CroFab) after developing recurrent/late coagulopathy following North American Rattlesnake Envenomation. Both patients were initially admitted and treated with CroFab following snakebite and discharged home without coagulopathy. One patient developed significant hypofibrinogenemia and subsequent hemorrhage after spontaneous abortion secondary to recurrent venom induced hypofibrinogenemia. Discussion: Pregnant women with recurrent or late coagulopathy may be at higher risk for hemorrhage and spontaneous abortion and require more frequent laboratory monitoring after initial hospitalization and treatment with antivenom. A lower threshold for re-treatment with CroFab may be warranted in patients with fibrinogen less than 100mg/dL even in the setting of a normal platelet count. Highlights: Recurrent coagulopathy can occur up to 14 days after rattlesnake envenomation in patients treated with CroFab. Pregnant women with coagulopathy after rattlesnake envenomation have increased risk of spontaneous abortion and hemorrhage. Re-treatment with CroFab should be considered in pregnant patients with fibrinogen less than 100mg/dL.