@article{ref1,
title="Lack of coagulopathy after copperhead snakebites",
journal="Annals of emergency medicine",
year="2014",
author="Ali, Anah J. and Horwitz, David A. and Mullins, Michael E.",
volume="65",
number="4",
pages="404-409",
abstract="STUDY OBJECTIVE: We determine the frequency and severity of abnormal laboratory measures of coagulation after suspected or known copperhead (Agkistrodon contortrix) envenomation. <br><br>METHODS: We identified the charts of venomous snakebites in children presenting to St. Louis Children's Hospital over a period of time greater than 14 years and of all venomous snakebites in adults presenting to Barnes-Jewish Hospital over a period of time greater than 11 years. We identified all known or suspected copperhead snakebites. We excluded bites by rattlesnakes, cottonmouths, unidentified snakes, and captive or non-native snakes. We classified the confidence that the culprit was a copperhead snake as &quot;positive&quot; or &quot;probable,&quot; according to the previously published criteria. We recorded the most extreme values for laboratory measures of coagulation for each patient. <br><br>RESULTS: The final data set included 106 venomous snakebites, of which 45 were positively identified as attributable to copperheads and 61 probable copperheads. <br><br>RESULTS for international normalized ratio (INR), partial thromboplastin time (PTT), platelet count, and fibrinogen concentration remained within normal limits for 79%, 93%, 95%, and 91% of patients, respectively. The highest INRs and PTTs were 1.35 and 41 seconds, respectively, in different patients. Three patients had platelet counts below 100,000/mm(3) (54,000, 75,000, and 76,000/mm(3), respectively). The lowest fibrinogen concentration was 117 mg/dL. Five patients had 2 laboratory values outside normal ranges, and 1 had 3 abnormal laboratory values. No patient developed bleeding complications. <br><br>CONCLUSION: In identified copperhead snakebites, it may be safe to forgo serial coagulation testing in both adult and pediatric patients in the absence of clinical evidence of bleeding.<p /> <p>Language: en</p>",
language="en",
issn="0196-0644",
doi="10.1016/j.annemergmed.2014.08.006",
url="http://dx.doi.org/10.1016/j.annemergmed.2014.08.006"
}