Peripheral Arterial Thrombosis following Russell's Viper Bites
Envenomings by Russell's viper (Daboia russelii), a species of high medical importance in India and other Asian countries, commonly result in hemorrhage, coagulopathies, necrosis, and acute kidney injury. Although bleeding complications are frequently reported following viper envenomings, throm...
| Main Authors: | , , , , , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
| Published: |
Georg Thieme Verlag KG
2023-04-01
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| Series: | TH Open |
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| Online Access: | http://www.thieme-connect.de/DOI/DOI?10.1055/s-0043-1769625 |
| _version_ | 1797801873837654016 |
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| author | Subramanian Senthilkumaran Ketan Patel Elanchezhian Rajan Pradeep Vijayakumar Stephen W. Miller Alexandra Rucavado Soheil Gilabadi Medha Sonavane Nicholas J. Richards Jarred Williams Harry F. Williams Steven A. Trim Ponniah Thirumalaikolundusubramanian José María Gutiérrez Sakthivel Vaiyapuri |
| author_facet | Subramanian Senthilkumaran Ketan Patel Elanchezhian Rajan Pradeep Vijayakumar Stephen W. Miller Alexandra Rucavado Soheil Gilabadi Medha Sonavane Nicholas J. Richards Jarred Williams Harry F. Williams Steven A. Trim Ponniah Thirumalaikolundusubramanian José María Gutiérrez Sakthivel Vaiyapuri |
| author_sort | Subramanian Senthilkumaran |
| collection | DOAJ |
| description | Envenomings by Russell's viper (Daboia russelii), a species of high medical importance in India and other Asian countries, commonly result in hemorrhage, coagulopathies, necrosis, and acute kidney injury. Although bleeding complications are frequently reported following viper envenomings, thrombotic events occur rarely (reported only in coronary and carotid arteries) with serious consequences. For the first time, we report three serious cases of peripheral arterial thrombosis following Russell's viper bites and their diagnostic, clinical management, and mechanistic insights. These patients developed occlusive thrombi in their peripheral arteries and symptoms despite antivenom treatment. In addition to clinical features, computed tomography angiography was used to diagnose arterial thrombosis and ascertain its precise locations. They were treated using thrombectomy or amputation in one case that presented with gangrenous digits. Mechanistic insights into the pathology through investigations revealed the procoagulant actions of Russell's viper venom in standard clotting tests as well as in rotational thromboelastometry analysis. Notably, Russell's viper venom inhibited agonist-induced platelet activation. The procoagulant effects of Russell's viper venom were inhibited by a matrix metalloprotease inhibitor, marimastat, although a phospholipase A2 inhibitor (varespladib) did not show any inhibitory effects. Russell's viper venom induced pulmonary thrombosis when injected intravenously in mice and thrombi in the microvasculature and affected skeletal muscle when administered locally. These data emphasize the significance of peripheral arterial thrombosis in snakebite victims and provide awareness, mechanisms, and robust strategies for clinicians to tackle this issue in patients. |
| first_indexed | 2024-03-13T04:58:11Z |
| format | Article |
| id | doaj.art-e6b9ec5c144240ea84a7a33893c4529e |
| institution | Directory Open Access Journal |
| issn | 2512-9465 |
| language | English |
| last_indexed | 2024-03-13T04:58:11Z |
| publishDate | 2023-04-01 |
| publisher | Georg Thieme Verlag KG |
| record_format | Article |
| series | TH Open |
| spelling | doaj.art-e6b9ec5c144240ea84a7a33893c4529e2023-06-17T22:41:15ZengGeorg Thieme Verlag KGTH Open2512-94652023-04-010702e168e18310.1055/s-0043-1769625Peripheral Arterial Thrombosis following Russell's Viper BitesSubramanian Senthilkumaran0Ketan Patel1Elanchezhian Rajan2Pradeep Vijayakumar3Stephen W. Miller4Alexandra Rucavado5Soheil Gilabadi6Medha Sonavane7Nicholas J. Richards8Jarred Williams9Harry F. Williams10Steven A. Trim11Ponniah Thirumalaikolundusubramanian12José María Gutiérrez13Sakthivel Vaiyapuri14Department of Emergency Medicine, Manian Medical Centre, Erode, Tamil Nadu, IndiaSchool of Biological Sciences, University of Reading, Reading, United KingdomSchool of Pharmacy, University of Reading, Reading, United KingdomSchool of Pharmacy, University of Reading, Reading, United KingdomThe Poison Control Center, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, United StatesInstituto Clodomiro Picado, Facultad de Microbiología, Universidad de Costa Rica, San José, Costa RicaSchool of Pharmacy, University of Reading, Reading, United KingdomSchool of Pharmacy, University of Reading, Reading, United KingdomSchool of Biological Sciences, University of Reading, Reading, United KingdomSchool of Pharmacy, University of Reading, Reading, United KingdomToxiven Biotech Private Limited, Coimbatore, Tamil Nadu, IndiaVenomtech Limited, Sandwich, United KingdomThe Tamil Nadu Dr M.G.R. Medical University, Chennai, Tamil Nadu, IndiaInstituto Clodomiro Picado, Facultad de Microbiología, Universidad de Costa Rica, San José, Costa RicaSchool of Pharmacy, University of Reading, Reading, United KingdomEnvenomings by Russell's viper (Daboia russelii), a species of high medical importance in India and other Asian countries, commonly result in hemorrhage, coagulopathies, necrosis, and acute kidney injury. Although bleeding complications are frequently reported following viper envenomings, thrombotic events occur rarely (reported only in coronary and carotid arteries) with serious consequences. For the first time, we report three serious cases of peripheral arterial thrombosis following Russell's viper bites and their diagnostic, clinical management, and mechanistic insights. These patients developed occlusive thrombi in their peripheral arteries and symptoms despite antivenom treatment. In addition to clinical features, computed tomography angiography was used to diagnose arterial thrombosis and ascertain its precise locations. They were treated using thrombectomy or amputation in one case that presented with gangrenous digits. Mechanistic insights into the pathology through investigations revealed the procoagulant actions of Russell's viper venom in standard clotting tests as well as in rotational thromboelastometry analysis. Notably, Russell's viper venom inhibited agonist-induced platelet activation. The procoagulant effects of Russell's viper venom were inhibited by a matrix metalloprotease inhibitor, marimastat, although a phospholipase A2 inhibitor (varespladib) did not show any inhibitory effects. Russell's viper venom induced pulmonary thrombosis when injected intravenously in mice and thrombi in the microvasculature and affected skeletal muscle when administered locally. These data emphasize the significance of peripheral arterial thrombosis in snakebite victims and provide awareness, mechanisms, and robust strategies for clinicians to tackle this issue in patients.http://www.thieme-connect.de/DOI/DOI?10.1055/s-0043-1769625russell's vipersnakebite envenomationthrombosisperipheral arteriesvenom |
| spellingShingle | Subramanian Senthilkumaran Ketan Patel Elanchezhian Rajan Pradeep Vijayakumar Stephen W. Miller Alexandra Rucavado Soheil Gilabadi Medha Sonavane Nicholas J. Richards Jarred Williams Harry F. Williams Steven A. Trim Ponniah Thirumalaikolundusubramanian José María Gutiérrez Sakthivel Vaiyapuri Peripheral Arterial Thrombosis following Russell's Viper Bites TH Open russell's viper snakebite envenomation thrombosis peripheral arteries venom |
| title | Peripheral Arterial Thrombosis following Russell's Viper Bites |
| title_full | Peripheral Arterial Thrombosis following Russell's Viper Bites |
| title_fullStr | Peripheral Arterial Thrombosis following Russell's Viper Bites |
| title_full_unstemmed | Peripheral Arterial Thrombosis following Russell's Viper Bites |
| title_short | Peripheral Arterial Thrombosis following Russell's Viper Bites |
| title_sort | peripheral arterial thrombosis following russell s viper bites |
| topic | russell's viper snakebite envenomation thrombosis peripheral arteries venom |
| url | http://www.thieme-connect.de/DOI/DOI?10.1055/s-0043-1769625 |
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