Handheld Point-of-Care Devices for Snakebite Coagulopathy: A Scoping Review

Michael Abouyannis; Amy E. Marriott; Emma Stars; Dianne P. Kitchen; Steve Kitchen; Tim A. L. Woods; Benno Kreuels; John H. Amuasi; Wuelton M. Monteiro; Ymkje Stienstra; Subramanian Senthilkumaran; Geoff K. Isbister; David G. Lalloo; Stuart Ainsworth; Nicholas R. Casewell

doi:10.1055/a-2407-1400

Thrombosis and Haemostasis, Inhaltsverzeichnis

CC BY-NC-ND 4.0 · Thromb Haemost 2025; 125(05): 405-420
DOI: 10.1055/a-2407-1400

Review Article

Handheld Point-of-Care Devices for Snakebite Coagulopathy: A Scoping Review

Michael Abouyannis

¹Centre for Snakebite Research and Interventions, Liverpool School of Tropical Medicine, Liverpool, United Kingdom

,

Amy E. Marriott

¹Centre for Snakebite Research and Interventions, Liverpool School of Tropical Medicine, Liverpool, United Kingdom

²Department of Infection Biology and Microbiomes, Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, Liverpool, United Kingdom

,

Emma Stars

¹Centre for Snakebite Research and Interventions, Liverpool School of Tropical Medicine, Liverpool, United Kingdom

,

Dianne P. Kitchen

³UK National External Quality Assessment Scheme for Blood Coagulation (UK NEQAS BC), Sheffield, United Kingdom

,

Steve Kitchen

³UK National External Quality Assessment Scheme for Blood Coagulation (UK NEQAS BC), Sheffield, United Kingdom

,

Tim A. L. Woods

³UK National External Quality Assessment Scheme for Blood Coagulation (UK NEQAS BC), Sheffield, United Kingdom

,

Benno Kreuels

⁴Department of Implementation Research, Bernhard Nocht Institute for Tropical Medicine, Hamburg, Germany

,

John H. Amuasi

⁴Department of Implementation Research, Bernhard Nocht Institute for Tropical Medicine, Hamburg, Germany

⁵Department of Global Health, School of Public Health, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana

,

Wuelton M. Monteiro

⁶College of Health Sciences, University of the State of Amazonas, Manaus, Brazil

⁷Department of Teaching and Research, Fundação de Medicina Tropical Dr Heitor Vieira Dourado, Manaus, Brazil

,

Ymkje Stienstra

¹Centre for Snakebite Research and Interventions, Liverpool School of Tropical Medicine, Liverpool, United Kingdom

⁸Department of Internal Medicine/Infectious Diseases, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands

,

Subramanian Senthilkumaran

⁹Department of Emergency and Critical Care, Manian Medical Centre, Erode, Tamil Nadu, India

,

Geoff K. Isbister

¹⁰Clinical Toxicology Research Group, University of Newcastle, Newcastle, NSW, Australia

,

David G. Lalloo

¹Centre for Snakebite Research and Interventions, Liverpool School of Tropical Medicine, Liverpool, United Kingdom

,

Stuart Ainsworth

¹Centre for Snakebite Research and Interventions, Liverpool School of Tropical Medicine, Liverpool, United Kingdom

²Department of Infection Biology and Microbiomes, Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, Liverpool, United Kingdom

,

Nicholas R. Casewell

¹Centre for Snakebite Research and Interventions, Liverpool School of Tropical Medicine, Liverpool, United Kingdom

› Institutsangaben

Abstract

Venom-induced consumption coagulopathy (VICC) is a common complication of snakebite that is associated with hypofibrinogenemia, 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 standardized, 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 prioritize certain devices for clinical validation studies. Four small studies have evaluated a POC international normalized ratio (INR) device in patients with Australian Elapid, Daboia russelii, and Echis carinatus envenoming. The devices assessed in these studies either relied on a thrombin substrate endpoint, which is known to underestimate INR in patients with hypofibrinogenemia, have been recalled due to poor accuracy, or have since been discontinued. Sixteen commercially available POC devices for measuring INR, activated clotting time, activated partial thromboplastin time, fibrinogen, D-dimer, and fibrin(ogen) degradation products have been reviewed. POC INR devices that detect fibrin clot formation, as well as a novel POC device that quantifies fibrinogen were identified, which 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.

Keywords

blood coagulation - point-of-care - snakebites - snake venoms

Volltext

Referenzen

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