Fresh Frozen Plasma

Does Fresh Frozen Plasma in Russell’s viper bite coagulopathy reduce the dose and duration of antivenom therapy?

Project Grant ID: NHMRC 631073
Principal Investigator: Prof. Geoff Isbister, University of Newcastle

One of the most important snakes is the Russell’s viper which causes about half of all snake bites in Sri Lanka and is the major cause of coagulopathy. Sri Lankan Russell’s viper bites also cause neurotoxicity characterised by cranial nerve effects, but rarely paralysis requiring intervention. This is most likely due to a presynaptic neurotoxin which does not appear to respond to antivenom.

We propose to undertake a dose finding controlled trial of fresh frozen plasma (FFP) and low dose antivenom versus standard dose antivenom in coagulopathy from Russell’s viper bites. This will be followed by a comparison of an optimised lower dose of antivenom in combination with FFP versus standard care to determine if this is a safer and more effective treatment of snakebite coagulopathy.

The aims of this project are to:

  1. Determine whether a smaller dose of antivenom (low dose antivenom) in combination with FFP results in more rapid restoration of clotting function in coagulopathic patients bitten by Russell’s vipers compared to standard large dose of antivenom without FFP.
  2. Determine if the use of low dose antivenom and FFP results in a lower acute reaction rate.
  3. Confirm the appropriate antivenom doses for coagulopathy in Russell’s viper bite.