Thrombelastography for Coagulopathy in Chinese Snakebites

Pit viper bites are a significant cause of envenomation in Guangzhou and surrounding regions, leading to severe coagulation disorders. Early and accurate assessment of coagulation function is critical for effective management and treatment. Traditional coagulation tests, such as prothrombin time (PT) and activated partial thromboplastin time (APTT), are commonly used but may not fully reflect the complex coagulopathy induced by venom.

This observational study will include patients who have been bitten by pit vipers in Guangzhou and surrounding areas. The aim is to evaluate the role of thromboelastography (TEG) in the diagnosis and management of coagulopathy in these patients. The investigators will compare TEG results with conventional coagulation tests (CCTs) to assess their agreement and the additional insights TEG may provide in identifying coagulation abnormalities.

The study will observe participants from the moment of admission and monitor their coagulation function through TEG and CCTs. Data will be collected on clinical outcomes, including any signs of disseminated intravascular coagulation (DIC), thromboembolic events, or bleeding complications. The investigators aim to identify the clinical value of TEG in managing coagulopathy in pit viper bite cases and to explore whether TEG can be used as a more reliable and timely diagnostic tool.

This study will help improve the understanding of coagulopathy induced by pit viper venom and may potentially guide the development of better diagnostic and treatment protocols for venomous snake bites.

Inclusion criteria

• Age: Participants aged 18-65 years.
• Diagnosis: Confirmed diagnosis of venom-induced consumptive coagulopathy caused by snake envenomation.
• Time of Enrollment: Participants who present with symptoms of venom poisoning within 6 hours of snake bite.
• Consent: Capable of providing written informed consent, or consent provided by a legal guardian if the participant is incapacitated.
• Vital Signs: Stable vital signs at the time of enrollment, with systolic blood pressure > 90 mmHg.
• Laboratory Results: Coagulation parameters (e.g., PT, aPTT, fibrinogen, platelet count) indicating acute coagulopathy.

Exclusion criteria

• Pregnancy or Breastfeeding: Women who are pregnant or breastfeeding.
• Severe Comorbidities: Participants with severe liver disease (e.g., cirrhosis), renal failure, or significant cardiovascular conditions (e.g., heart failure).
• Previous Snake Envenomation: Participants who have received antivenom for a snake bite in the past 30 days.
• Severe Allergies: Known allergy to snake venom antivenom or any of its components.
• Concurrent Participation in Other Clinical Trials: Participants who are currently enrolled in another clinical trial.
• Severe Coagulopathy or Bleeding Disorders: Participants with known pre-existing coagulation disorders such as hemophilia, or those with abnormal baseline blood tests suggesting coagulopathy unrelated to the snake bite.
• Immunocompromised Patients: Individuals with HIV/AIDS, or who are on immunosuppressive therapy.