Trial of low molecular weight heparin in the treatment of viper bites.

AIM OF THE STUDY: To study the efficacy of low molecular weight heparin (LMWH) in the treatment of viper envenomation to combat the haematotoxicity and disseminated intravascular coagulation (DIC). METHODOLOGY: Eighty patients with viper bite and incoagulable blood were randomized into two groups of 40 each. One group (Test group) received LMWH, in addition to the antisnake venom (ASV) and other routine measures received by the other group (Control group). Efficacy was assessed by monitoring the bleeding time (BT), whole blood clotting time (CT), prothrombin time (PT), platelet count, fibrinogen, blood urea (BU), serum creatinine, development of complications and overall outcome. RESULTS: LMWH group showed favourable outcome in all the parameters except in the incidence of renal failure which was reversible in the majority of the cases. However the differences between the two groups were statistically not significant. CONCLUSION: LMW heparin seems to have a beneficial role in the treatment of viper bites, but this needs to be confirmed by a larger trial using a higher dose of heparin.

High-dose anti-snake venom versus low-dose anti-snake venom in the treatment of poisonous snake bites--a critical study.

OBJECTIVES: To asses the optimum dose of anti-snake venom to treat snake bites cases effectively. This is particulary relevant in the present scenario when the cost of anti-snake venom ( Serum Institute of India) has gone up to nearly Rs. 400 per vial and the cross-section of people usually affected belong to the poor socioeconomic class. METHODOLOGY: One hundred snake bite cases with envenomation, irrespective of whether they were bitten by viper, cobra or krait, brought within 24 hours of the bite to Jubilee Mission Hospital, Trichur, Kerala State during the 15 months from August 2001 to October 2002 were randomized into two groups of 50 cases each, irrespective of the severity of the cases. One group received a fixed dose regime of six vials of anti-snake venom and the other 12 vials of the same. RESULTS: In the low-dose group there were five deaths giving a mortality rate of 10%, nine (18%) required dialysis and three (6%) required ventilatory support. In the high-dose group there were seven deaths giving a mortality rate of 14%, 13 (26%) required dialysis and three (6%) required ventilatory support. The average hospital stay for the low-dose group was 8.42 days while that of the high-dose group was 9.02 days. CONCLUSION: While there was no additional advantage in following a high-dose regime for snake bite cases, there was considerable financial gain by following the low-dose regime, Most of the parameters showed a beneficial trend for the low-dose group though the differences were not statistically significant.