In vitro correction of venom-induced coagulopathy in Daboia russelii envenomation demonstrated using tranexamic acid-modified rotational thromboelastometry.
Aboobacker Mohamed Rafi, Siju V Abraham, Susheela J Innah et al.
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Case in brief
A man in his late 40s presented soon after Russell’s viper envenomation with local signs and a prolonged modified Lee and White clotting time, despite normal prothrombin and activated partial thromboplastin times. ROTEM showed rapid, complete clot lysis on EXTEM; tranexamic acid-modified t-APTEM restored clot stability, supporting a hyperfibrinolytic component. He received antivenom and supportive care, including plasma transfusion. The coagulopathy resolved, and he recovered without complications.
What made this case unusual
The bedside clotting time was prolonged while conventional coagulation tests were normal; ROTEM revealed rapid clot lysis that was inhibited in tranexamic acid-modified t-APTEM.
Diagnostic / clinical pearl
When bedside clotting time and conventional coagulation tests disagree after snakebite, ROTEM may help identify clot lysis and a hyperfibrinolytic component.
Why it matters
The report highlights a potential role for systematic assessment of fibrinolysis in snakebite-associated coagulopathy; the role of antifibrinolytic therapy remains to be explored.