Citation

Noutsos T, Isbister GK. Expert Rev Clin Pharmacol 2023; ePub(ePub): ePub.

Copyright

(Copyright © 2023, Informa Healthcare)

DOI

10.1080/17512433.2023.2220963

PMID

37259708

Abstract

INTRODUCTION: Snakebite is a neglected public health issue causing death and disability, disproportionately affecting tropical and subtropical resource poor countries globally. Snakebite-associated thrombotic microangiopathy (TMA) occurs in a subset of snakebites and is associated with acute kidney injury (sometimes requiring renal replacement therapy), and a risk of chronic kidney disease. AREAS COVERED: This expert review synthesizes current evidence on therapeutic interventions in snakebite-associated TMA, via PubMed search for cohort studies and randomized controlled trials (RCT) in snakebite-associated TMA from 1970 to October 2022. EXPERT OPINION: There are no interventional RCTs in snakebite-associated TMA. Recent cohort studies from Sri Lanka, India and Australia report clinical and laboratory endpoint outcomes for intervention with antivenom and therapeutic plasma-exchange (TPE). TPE is a resource intense and costly treatment using large volumes of blood donor plasma. There is no consistent evidence supporting TPE in snakebite-associated TMA with respect to patient survival, dialysis free survival, or hospital length of stay. Antivenom is the standard of care for patients with snake envenoming, but there is no specific evidence of benefit in snakebite-associated TMA. Emerging new therapies in snakebite more broadly are untested in snakebite-associated TMA. RCTs are needed to improve the evidence for treatment of snakebite-associated TMA.

Language: en

Keywords

acute kidney injury; antivenom; fresh frozen plasma; hemolysis; neglected tropical diseases; schistocytes; snakebite; snakes; therapeutic plasma exchange; thrombotic microangiopathies; venom