PB0135 - Correlations between rotational thromboelastometry (ROTEM) and standard coagulation tests following snakebites in a tertiary care center in Kerala

Background: A high prevalence of venom-induced consumption coagulopathy has been reported in individuals with viper snakebites. Rotational thromboelastometry (ROTEM) is a rapid technique that could be advantageous in assessing and monitoring coagulation disorders

Aims: To explore Correlations between rotational thromboelastometry (ROTEM) and standard coagulation tests following snake bites.
Comparison of rotational thromboelastometry parameters with 20-minute whole blood clotting test as a predictor of envenoming in Hematotoxic bite patients

Methods: Prospective observational study on patients with history suggestive of snakebite presenting within 6 hours of snakebite and admitted to the Emergency Medicine department .All providing a written informed consent and/or assent and satisfying the criteria were included. Standard coagulation measurements [platelet count, prothrombin time (PT), activated partial thromboplastin time (aPTT), fibrinogen level] and ROTEM parameters [clotting time (CT), amplitude (at set time: 5 s), maximum clot firmness (MCF) for extrinsic (EXTEM and fibrin based (FIBTEM) ROTEM] were obtained. This Data was analysed and compared.

Results: A total of 96 patients were enrolled in this study .The mean age of the patients was 42.69 (IQR:28-57,SD+18.12).More than half of them were males (n=63,65.6%).96 cases recruited-54 Identified & 42 unidentified. 32 identified as venomous snakes.14 were Russell's vipers , 11 were Hump-nosed Pit vipers,3 kraits & 3 cobras & 1 Malabar pit viper.22 out of 96 patients exhibited coagulopathy which lasted for an average of 12.8 ± hours.8 patients required blood products. Two patients also underwent dialysis.

Conclusion(s): ROTEM appeared more sensitive to identify envenoming-Could pick up subtle changes in coagulation.POCT by non laboratory personnel.Getting a numerical value – For initial and Post ASV assessment. Ability to detect hyperfibrinolysis .The clinical utility of detecting VICC and their usefulness in managing snakebite should be further explored. Especially useful in Patients in whom ASV is not available to detect and manage coagulopathy