Envenomation by the Bothrops lanceolatus, a snake found only in Martinique, leads to swelling and
pain, and occasionally to systemic signs and/or coagulopathy. Severe
thromboses at some distance from the site of the
bite may appear within 48 hr. Uncertainties as to the actual development of thrombotic complications in patients appearing to be suffering from moderate
poisoning and as to the availability and the toxicity of a monospecific
antivenom (AVS) initially led us to reserve
antivenom for the most severe cases, and to use
anticoagulants to prevent
thromboses in all patients. This approach was modified after we observed serious
thromboses in patients with moderate
poisoning. Of 50 adult
snake bite cases hospitalized between June 1991 and August 1994, 11 developed serious thrombotic complications at 36 /+- 27 hr (mean +/- SD) (range 12-96) following envenomation, despite early preventive
anticoagulant therapy. Those included
pulmonary embolism (two cases),
cerebral infarction (six cases),
myocardial infarction (one case), and cerebral and
myocardial infarctions (two cases). Sixteen patients were not treated with AVS: 10 of these recovered without complications and six developed systemic
thrombosis causing permanent disability in three cases. Thirty were treated with an
intravenous infusion of 2-6 vials of AVS given 2-48 hr after the
bite. Of these, three died of
cerebral infarction that developed before the initiation of serotherapy. All others recovered. Among patients treated with AVS, three presented with mild
anaphylactic reactions, while one developed
serum sickness that responded to
steroids. These data indicate that preventive
anticoagulant therapy is of limited efficacy in Martinique.(ABSTRACT TRUNCATED AT 250 WORDS)