Recurrent coagulopathy after antivenom treatment of crotalid snakebite

Background. We studied whether recurrence of coagulopathy defined as the re turn of a coagulation abnormality after initial normalization, occurred aft er the use of antivenin (Crotalidae) polyvalent. Methods. A retrospective, blinded, descriptive analysis of 354 consecutive crises of North American crotalid snake envenomation was done. Inclusion cr iteria were documented clinical evidence of crotalid snakebite, presence of a coagulopathy (platelet count <150,000/mm(3), prothrombin time above norm al, or fibrinogen level <150 mg/dL), and treatment with antivenin (Crotalid ae) polyvalent. Results. Of 112 cases with a coagulopathy extending beyond 6 hours after en venomation, 31 had sufficient coagulopathy testing to detect recurrence. Fo urteen of these patients (45%) had recurrence of coagulopathy and two cases were severe (fibrinogen level 29 mg/dL; platelet count 36,000/mm(3)). Conclusion. Recurrence of coagulopathy after envenomation by North American crotalid snakes may occur after use of antivenin (Crotalidae) polyvalent a nd can result in severe coagulation abnormalities.