Reliability of the 20 minute whole blood clotting test as an indicator of coagulopathy in patients envenomed by Sri Lankan Viperidae snakes

Abstract

Snake bites carry a high rate of morbidity and mortality as a result of the local and multi systemic complications. There is an estimated 40,000 snake bites every year in Sri Lanka. Coagulopathy is one of the main complications caused by the venom of Viperidae. The toxic effect of the venom activates enzymatic pathways which results in crisis of homeostasis. The current practice of detection of coagulopathy is by the 20 minutes whole blood clotting time (20 WBCT). Coagulopathy also leads to the alterations of Prothrombin Time (PT), INR, Activated Partial Thromboplastin Time (APTT) and Thrombin Time (TT). A discrepancy between 20 WBCT and the coagulation profile has been observed in some instances. A recent study concluded that WBCT was not a good test to identify coagulopathy in Russell’s viper envenomation.