dosage comparison of snake anti-venom on coagulopathy

this study was done to determine whether high or low dose of anti-snake venom (asv) is better in coagulopathy in victims of envenoming by vipers. this retrospective study was conducted on the 154 patients (mean age ± sd, range) of viper snake bites who were referred to the emergency ward of razi hospital, ahvaz, iran over 2 years period (2004 - 2006). according to the treatment dosage the patients were divided in two groups include group 1 (78 cases), low dose regimen and group 2 (76 cases), high dose one. in group 1, the treatment was performed by administration of 4 to 6 vials of asv through intravenous infusion. in group 2, the patients were given 5 to 10 vials of asv as an initial dose. in low dose regimen, the number of received packed red blood cell was higher (14 vs. 3) in comparison with high dose group. the number of asv vials the patients received was 5.5and 21.06 in group 1 and 2, respectively (5.5 ± 1.7 vs. 21.06 ± 10.89; p < 0.01). the difference in frequency of coagulopathy complications, and need for using packed red blood cell were statistically significant (96.2% and 17.9% in group 1 vs. 34.2% and 3.9% in group 2, p < 0.01). it seems that cautious usage of high dose of asv (10 - 20 vials) without very special concerns about the cost, dose, and without hazardous side effects is essential for the routine management of sever snake envenoming.