Peripheral Arterial Thrombosis following Russell's Viper Bites

Author:

Senthilkumaran Subramanian1,Patel Ketan2,Rajan Elanchezhian3,Vijayakumar Pradeep3,Miller Stephen W.4,Rucavado Alexandra5,Gilabadi Soheil3,Sonavane Medha3,Richards Nicholas J.2,Williams Jarred3ORCID,Williams Harry F.6,Trim Steven A.7,Thirumalaikolundusubramanian Ponniah8,Gutiérrez José María5,Vaiyapuri Sakthivel3

Affiliation:

1. Department of Emergency Medicine, Manian Medical Centre, Erode, Tamil Nadu, India

2. School of Biological Sciences, University of Reading, Reading, United Kingdom

3. School of Pharmacy, University of Reading, Reading, United Kingdom

4. The Poison Control Center, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, United States

5. Instituto Clodomiro Picado, Facultad de Microbiología, Universidad de Costa Rica, San José, Costa Rica

6. Toxiven Biotech Private Limited, Coimbatore, Tamil Nadu, India

7. Venomtech Limited, Sandwich, United Kingdom

8. The Tamil Nadu Dr M.G.R. Medical University, Chennai, Tamil Nadu, India

Abstract

AbstractEnvenomings by Russell's viper (Daboia russelii), a species of high medical importance in India and other Asian countries, commonly result in hemorrhage, coagulopathies, necrosis, and acute kidney injury. Although bleeding complications are frequently reported following viper envenomings, thrombotic events occur rarely (reported only in coronary and carotid arteries) with serious consequences. For the first time, we report three serious cases of peripheral arterial thrombosis following Russell's viper bites and their diagnostic, clinical management, and mechanistic insights. These patients developed occlusive thrombi in their peripheral arteries and symptoms despite antivenom treatment. In addition to clinical features, computed tomography angiography was used to diagnose arterial thrombosis and ascertain its precise locations. They were treated using thrombectomy or amputation in one case that presented with gangrenous digits. Mechanistic insights into the pathology through investigations revealed the procoagulant actions of Russell's viper venom in standard clotting tests as well as in rotational thromboelastometry analysis. Notably, Russell's viper venom inhibited agonist-induced platelet activation. The procoagulant effects of Russell's viper venom were inhibited by a matrix metalloprotease inhibitor, marimastat, although a phospholipase A2 inhibitor (varespladib) did not show any inhibitory effects. Russell's viper venom induced pulmonary thrombosis when injected intravenously in mice and thrombi in the microvasculature and affected skeletal muscle when administered locally. These data emphasize the significance of peripheral arterial thrombosis in snakebite victims and provide awareness, mechanisms, and robust strategies for clinicians to tackle this issue in patients.

Publisher

Georg Thieme Verlag KG

Subject

Hematology

Reference60 articles.

同舟云学术

1.学者识别学者识别

2.学术分析学术分析

3.人才评估人才评估

"同舟云学术"是以全球学者为主线,采集、加工和组织学术论文而形成的新型学术文献查询和分析系统,可以对全球学者进行文献检索和人才价值评估。用户可以通过关注某些学科领域的顶尖人物而持续追踪该领域的学科进展和研究前沿。经过近期的数据扩容,当前同舟云学术共收录了国内外主流学术期刊6万余种,收集的期刊论文及会议论文总量共计约1.5亿篇,并以每天添加12000余篇中外论文的速度递增。我们也可以为用户提供个性化、定制化的学者数据。欢迎来电咨询!咨询电话:010-8811{复制后删除}0370

www.globalauthorid.com

TOP

Copyright © 2019-2024 北京同舟云网络信息技术有限公司
京公网安备11010802033243号  京ICP备18003416号-3