COAGULOPATHY FOLLOWING BITES BY THE PAPUAN TAIPAN (OXYURANUS-SCUTELLATUS CANNI)

The mechanisms of haemostatic failure were studied in 87 patients bitt en by the Papuan taipan (Oxyuranus scutellatus canni). Eighty (92%) ha d evidence of a coagulopathy on laboratory testing; 36 (41.4%) develop ed spontaneous systemic bleeding, although this was rarely of clinical significance. Coagulation assays in 48 completely defibrinated patien ts showed marked reductions in factors V and VIII and reductions in fa ctors II, IX, XI, XII and XIIIA. There was a reduction in plasminogen and alpha(2)-antiplasmin levels and both total and cross-linked fibrin (ogen) degradation products (FDP) levels were elevated. The mean plate let count was initially decreased and fell further during admission. S imilar but less severe changes were seen in patients who were mildly d efibrinated. Following treatment with antivenom, fibrinogen levels ros e rapidly and coagulability was restored within 6-12 h in 93% of patie nts. These abnormalities may be primarily attributable to the prothrom bin activator present in taipan venom, but it is likely that other unc haracterized venom components contributed.