Handheld point-of-care devices for snakebite coagulopathy: a scoping review

Abouyannis, Michael ORCID: https://orcid.org/0000-0003-4856-4334, Marriott, Amy, Stars, Emma, Kitchen, Dianne P, Kitchen, Steve, Woods, Tim A.L, Kreuels, Benno, Amuasi, John H, Monteiro, Wuelton Marcelo, Stienstra, Ymkje, Senthilkumaran, Subramanian, Isbister, Geoffrey K, Lalloo, David ORCID: https://orcid.org/0000-0001-7680-2200, Ainsworth, Stuart ORCID: https://orcid.org/0000-0002-0199-6482 and Casewell, Nicholas ORCID: https://orcid.org/0000-0002-8035-4719 (2024) 'Handheld point-of-care devices for snakebite coagulopathy: a scoping review'. Thrombosis and Haemostasis. (In Press)

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Abstract

Venom induced consumption coagulopathy (VICC) is a common complication of snakebite that is associated with hypofibrinogenaemia, bleeding, disability, and death. In remote tropical settings, where most snakebites occur, the 20-minute whole blood clotting test is used to diagnose VICC. Point-of-care (POC) coagulation devices could provide an accessible means of detecting VICC that is better standardised, quantifiable, and more accurate. In this scoping review, the mechanistic reasons that previously studied POC devices have failed in VICC are considered, and evidence-based recommendations are made to prioritise certain devices for clinical validation studies. Four small studies have evaluated a POC international normalised ratio (INR) device in patients with Australian Elapid, Daboia russelii and Echis carinatus envenoming. All of these studies used POC INR devices that rely on a thrombin substrate endpoint, which, unlike laboratory-based INR measurement, is known to underestimate INR in patients with hypofibrinogenaemia. Seventeen commercially available POC devices for measuring INR, activated clotting time (ACT), activated partial thromboplastin time (aPTT), fibrinogen, D-dimer, and fibrin(ogen) degradation products (FDP) have been reviewed. POC INR devices that detect fibrin clot formation, as well as a novel POC device that quantifies fibrinogen were identified, that show promise for use in patients with VICC. These devices could support more accurate allocation of antivenom, reduce the time to antivenom administration, and provide improved clinical trial outcome measurement instruments. There is an urgent need for these promising POC coagulation devices to be validated in prospective clinical snakebite studies.

Item Type:	Article
Subjects:	WD Disorders of Systemic, Metabolic or Environmental Origin, etc > Animal Poisons > WD 410 Reptiles WH Hemic and Lymphatic Systems > Hematologic Diseases. Immunologic Factors. Blood Banks > WH 322 Blood coagulation disorders (General)
Faculty: Department:	Biological Sciences > Department of Tropical Disease Biology Clinical Sciences & International Health > Clinical Sciences Department
Digital Object Identifer (DOI):	https://doi.org/10.1055/a-2407-1400
SWORD Depositor:	JISC Pubrouter
Depositing User:	JISC Pubrouter
Date Deposited:	26 Sep 2024 10:34
Last Modified:	26 Sep 2024 10:40
URI:	https://archive.lstmed.ac.uk/id/eprint/25298

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