• 主题
高级搜索  >
历史搜索 清空历史
首页> 外文期刊>PLOS Neglected Tropical Diseases >Current Treatment for Venom-Induced Consumption Coagulopathy Resulting from Snakebite
【24h】

Current Treatment for Venom-Induced Consumption Coagulopathy Resulting from Snakebite

机译：蛇咬伤致毒引起的消耗性凝血病的当前治疗

获取原文
           
页面导航
  • 摘要
  • 著录项
  • 相似文献
  • 相关主题

摘要

Venomous snakebite is considered the single most important cause of human injury from venomous animals worldwide. Coagulopathy is one of the commonest important systemic clinical syndromes and can be complicated by serious and life-threatening haemorrhage. Venom-induced consumption coagulopathy (VICC) is the commonest coagulopathy resulting from snakebite and occurs in envenoming by Viperid snakes, certain elapids, including Australian elapids, and a few Colubrid (rear fang) snakes. Procoagulant toxins activate the clotting pathway, causing a broad range of factor deficiencies depending on the particular procoagulant toxin in the snake venom. Diagnosis and monitoring of coagulopathy is problematic, particularly in resource-poor countries where further research is required to develop more reliable, cheap clotting tests. MEDLINE and EMBASE up to September 2013 were searched to identify clinical studies of snake envenoming with VICC. The UniPort database was searched for coagulant snake toxins. Despite preclinical studies demonstrating antivenom binding toxins (efficacy), there was less evidence to support clinical effectiveness of antivenom for VICC. There were no placebo-controlled trials of antivenom for VICC. There were 25 randomised comparative trials of antivenom for VICC, which compared two different antivenoms (ten studies), three different antivenoms (four), two or three different doses or repeat doses of antivenom (five), heparin treatment and antivenom (five), and intravenous immunoglobulin treatment and antivenom (one). There were 13 studies that compared two groups in which there was no randomisation, including studies with historical controls. There have been numerous observational studies of antivenom in VICC but with no comparison group. Most of the controlled trials were small, did not use the same method for assessing coagulopathy, varied the dose of antivenom, and did not provide complete details of the study design (primary outcomes, randomisation, and allocation concealment). Non-randomised trials including comparison groups without antivenom showed that antivenom was effective for some snakes (e.g., Echis), but not others (e.g., Australasian elapids). Antivenom is the major treatment for VICC, but there is currently little high-quality evidence to support effectiveness. Antivenom is not risk free, and adverse reactions can be quite common and potentially severe. Studies of heparin did not demonstrate it improved outcomes in VICC. Fresh frozen plasma appeared to speed the recovery of coagulopathy and should be considered in bleeding patients.
机译：毒蛇咬伤被认为是全世界有毒动物对人造成伤害的最重要原因。凝血障碍是最常见的重要全身性临床综合征之一，并可能因严重且危及生命的出血而复杂化。毒引起的消耗性凝血病（VICC）是蛇咬引起的最常见的凝血病，发生在由蛇毒蛇，某些弹性体（包括澳大利亚弹性体）和一些Colubrid（后牙）蛇的毒化中。促凝毒素激活凝血途径，根据蛇毒中特定的促凝毒素，导致广泛的因子缺陷。凝血病的诊断和监测存在问题，特别是在资源匮乏的国家，需要进一步研究以开发更可靠，更便宜的凝血试验。检索截至2013年9月的MEDLINE和EMBASE，以鉴定VICC对蛇毒的临床研究。在UniPort数据库中搜索了凝结性蛇毒素。尽管临床前研究表明抗蛇毒毒素具有结合毒素（功效），但很少有证据支持抗蛇毒血清对VICC的临床有效性。目前尚无针对VICC的抗蛇毒子的安慰剂对照试验。 VICC有25例抗癫痫药的随机对照试验，比较了两种不同的抗癫痫药（十项研究），三种不同的抗癫痫药（四种），两种或三种不同剂量或重复剂量的抗癫痫药（五种），肝素治疗和抗癫痫药（五种），以及静脉注射免疫球蛋白和抗蛇毒血清（一）。有13项研究将没有随机分组的两组进行了比较，包括采用历史对照的研究。在VICC中有许多有关抗蛇毒素的观察研究，但没有对照组。大多数对照试验规模很小，没有使用相同的方法评估凝血功能障碍，改变了抗蛇毒血清的剂量，并且没有提供研究设计的完整细节（主要结果，随机分组和分配隐藏）。包括无抗蛇毒血清的比较组在内的非随机试验表明，抗蛇毒血清对某些蛇（如Echis）有效，但对另一些蛇（如澳大利亚长尾蛇）则无效。抗毒液是VICC的主要治疗方法，但目前尚无高质量证据可证明其有效性。抗毒液并非没有风险，不良反应可能非常普遍，甚至可能很严重。肝素的研究并未证明其改善了VICC的预后。新鲜的冷冻血浆似乎可以加快凝血功能障碍的恢复，出血患者应考虑使用。

著录项

相似文献

  • 外文文献
  • 中文文献
  • 专利
获取原文

客服邮箱：kefu@zhangqiaokeyan.com

京公网安备：11010802029741号 ICP备案号：京ICP备15016152号-6 六维联合信息科技 (北京) 有限公司©版权所有

  • 客服微信

  • 服务号