Citation

Jollivet V, Hamel JF, de Haro L, Labadie M, Sapori JM, Cordier L, Villa A, Nisse P, Puskarczyk E, Berthelon L, Harry P, Boels D. Toxicon 2015; 108: 97-103.

Affiliation

Poison Control Center, Angers University Hospital, France. Electronic address: daboels@chu-angers.fr.

Copyright

(Copyright © 2015, Elsevier Publishing)

DOI

10.1016/j.toxicon.2015.09.039

PMID

26454165

Abstract

INTRODUCTION: Immunotherapy is the gold standard treatment for patients bitten by European vipers in France; it significantly decreases morbidity, frequency and severity of complications and length of stay. A national prospective study was performed by all Poison Control Centers (PCC) to validate the emergency protocol for viper envenomations.

METHODS: This prospective study included all cases of viper bites in France, treated or not with Viperfav® in 2013.

RESULTS: In 2013, 277 cases of viper bites were collected: ratio M/F 2.1; mean aged 43 years (<15 years 25% 15-65 63% >65 12%). The final severity was divided into 68 grades 0, 58 grades I, 62 grades IIA, 71 grades IIB and 18 grades III. One death was reported. Five patients had neurological signs. For the 114 patients who received Viperfav®, all systemic signs disappeared in 5 h and in 24 h for biological and neurological signs. No severe anaphylactic reaction with Viperfav® was reported. Late Viperfav® administration increased the risk of functional impairment 15 days after the bite (OR=3.21 p=0.043). The administration of Low Molecular Weight Heparin (LMWH) increased the frequency of functional impairment to 15 days after the bite (OR=6.38 p=0.064), although Viperfav® was given in the first 18 hours.

DISCUSSION: This study confirms the efficiency, safety and recommendation of an early administration of a single dose of Viperfav®, LMWH should not be used. It also shows the extension of neurotoxic venom of vipers in France.

Language: en