TY  - JOUR
PY  - 2019//
TI  - "Bad things come in small packages": predicting venom-induced coagulopathy in Bothrops atrox bites using snake ontogenetic parameters
JO  - Clinical toxicology (Philadelphia, Pa.)
A1  - Bernal, Jorge Carlos Contreras
A1  - Bisneto, Pedro Ferreira
A1  - Pereira, João Pedro Tavares
A1  - Ibiapina, Hiochelson Najibe Dos Santos
A1  - Sarraff, Lybia Kássia Santos
A1  - Monteiro-Júnior, Cláudio
A1  - da Silva Pereira, Handerson
A1  - Santos, Bruno
A1  - de Moura, Valeria Mourão
A1  - de Oliveira, Sâmella Silva
A1  - Lacerda, Marcus
A1  - Sampaio, Vanderson
A1  - Kaefer, Igor Luis
A1  - Gutiérrez, José María
A1  - Bernarde, Paulo Sérgio
A1  - Fan, Hui Wen
A1  - Sachett, Jacqueline de Almeida Gonçalves
A1  - da Silva, Ana Maria Moura
A1  - Monteiro, Wuelton Marcelo
SP  - 1
EP  - 9
VL  - ePub
IS  - ePub
N2  - <b>Introduction:</b> Snake venom composition shows significant inter- and intra-species variation. In the case of the viperid species <i>Bothrops atrox</i>, responsible for the majority of snakebites in the Amazon region, geographical and ontogenetic variables affect venom composition, with ecological and medical implications. Previous studies had shown that venom from neonate and juvenile <i>Bothrops</i> specimens have a higher <i>in vitro</i> coagulant activity. The aim of this investigation was to assess the association of clinical outcomes, such as venom-induced coagulopathy and local complications, with <i>B. atrox</i> ontogenetic variables. <b>Methods:</b> This study explored the relationship between some clinical parameters in patients suffering envenomations by <i>B. atrox</i> in the Amazon and several morphometric parameters of the snake specimens causing the bites. <b>Results:</b> There were 248 specimens confirmed as agents of envenomation, mostly female snakes (70.5%) and classified as juveniles (62.7%). Patients bitten by neonates compared to adult snakes [OR = 2.70 (95%CI 1.15-6.37); <i>p</i> = .021] and by snakes with white tail tip [OR = 1.98 (95%CI 1.15-3.41); <i>p</i> = .013] were more likely to develop coagulopathy. Time from patient admission to the unclottable blood reversion was not affected by the snake gender (<i>p</i> = .214) or age (<i>p</i> = .254). Patients bitten by neonate (<i>p</i> = .024) or juvenile snakes (<i>p</i> < .0001) presented a lower frequency of moderate to severe edema, as compared to those bitten by adult snakes. In agreement with experimental observations, patients bitten by neonates and by snakes with a white tail tip were more likely to develop coagulopathy than those bitten by adult snakes. In contrast, envenomations by adult snakes were associated with a higher incidence of severe local edema. <b>Conclusion:</b> Despite these variations, no difference was observed in the time needed to recover blood clotting in these patients after <i>Bothrops</i> antivenom administration.<p />  <p>Language: en</p>
LA  - en
SN  - 1556-3650
UR  - http://dx.doi.org/10.1080/15563650.2019.1648817
ID  - ref1
ER  -