Disseminated Intravascular Coagulation Caused by the Carpet Viper (Echis carinatus): Trial of Heparin

Summary. Heparin has been advocated for the treatment of poisoning by Echis carinatus, a snake whose venom causes disseminated intravascular coagulation. Fourteen patients with proven E. carinatus bite who had incoagulable blood were treated with specific Echis antivenom, Seven of them were also given low‐dose heparin, initially 50 units/kg body weight by i.v. injection, followed by 10 units/kg/h by i.v. infusion for 22 h. Response to treatment was assessed clinically and by repeated tests of blood coagulation. All patients showed a rapid return to normal blood coagulability after treatment and the heparinized group were not significantly different in any respect from the group given antivenom alone. Heparin did not reduce the local effects of envenoming. There appears to be no place for heparin in the treatment of E. carinatus poisoning provided that potent antivenom is available. The in vivo results were supported by in vitro studies in which it was found that Echis‐induced thrombin was less sensitive to the inhibitory effect of heparin than physiological thrombin.

[1]  B. Greenwood,et al.  Necrosis, haemorrhage and complement depletion following bites by the spitting cobra (Naja nigricollis). , 1976, The Quarterly journal of medicine.

[2]  J. Finlayson,et al.  Activation of human prothrombin by a procoagulant fraction from the venom of Echis carinatus. Identification of a high molecular weight intermediate with thrombin activity. , 1975, The Journal of biological chemistry.

[3]  Straub Pw.  A case against heparin therapy of intravascular coagulation. , 1975 .

[4]  B. Blombäck,et al.  Prothrombin activation induced by Ecarin - a prothrombin converting enzyme from Echis carinatus venom. , 1975, Thrombosis research.

[5]  P. Straub.  A Case against Heparin Therapy of Intravascular Coagulation , 1975, Thrombosis and Haemostasis.

[6]  B. Greenwood,et al.  Immunodiagnosis of Snake Bite , 1974, British medical journal.

[7]  B. Greenwood,et al.  Bites by the Saw-scaled or Carpet Viper (Echis carinatus): Trial of Two Specific Antivenoms , 1974, British medical journal.

[8]  A. Livne,et al.  Impairment of Human Platelet Aggregation and Serotonin Release Caused in Vitro by Echis Colorata Venom , 1973, Thrombosis and Haemostasis.

[9]  H. Weiss,et al.  Heparin therapy in a patient bitten by a saw-scaled viper (Echis carinatus), a snake whose venom activates prothrombin. , 1973, The American journal of medicine.

[10]  E. Habermann,et al.  [Influence of Echis carinata venom on hemostasis]. , 1971, Thrombosis et diathesis haemorrhagica.

[11]  P. Pudlák,et al.  A prolonged defibrination caused by Echis carinatus venom. , 1971, Life sciences. Pt. 2: Biochemistry, general and molecular biology.

[12]  M. Stahl,et al.  The effect of proteolytic enzymes on fibrin stabilizing factor. , 1969, Biochimica et biophysica acta.

[13]  A. Mohamed,et al.  Observations on the effects of Echis carinatus venom on blood clotting. , 1969, Toxicon : official journal of the International Society on Toxinology.

[14]  A. S. Douglas,et al.  Studies on East African Snakes , 1966, Scottish medical journal.

[15]  R. Lerner.  Defibrination syndrome. , 1976, British medical journal.

[16]  R. Higginbotham.  Mast cells and local resistance to Russell's viper venom. , 1965, Journal of immunology.

[17]  B. Moav,et al.  Prevention of Echis colorata Venom-Induced Afibrinogenemia by Heparin. , 1963 .

[18]  M. L. Ahuja,et al.  Action of Heparin on the Venom of Echis carinatus , 1946, Nature.

[19]  J. Taylor,et al.  Observations on the Neutralization of the Haemorrhagin of Certain Viper Venoms by Antivenene. , 1935 .