Medecine tropicale et sante internationale · 2026
[Evaluation of the Efficacy and Tolerance of Tranexamic Acid Combined with InoserpTM PAN-AFRICA Antivenom in the Treatment of Hemorrhagic Syndrome during Envenomation by Echis ocellatus in Benin].
СтатьяРандомизированное исследованиеАннотация на английскомНазвание и аннотация: Перевод в очереди
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Larréché Sébastien, Sodjinou Noé, Tourita Naryanan, Ouorou Seidou Alassane, Ganhouingnon Éric, Layo Édith Aloukoutou, Massougbodji Achille, Chippaux Jean-Philippe
Аннотация
INTRODUCTION: Hemorrhagic syndrome accounts for a significant proportion of the mortality and morbidity associated with snakebites in sub-Saharan Africa. Hyperfibrinolysis, which has been reported in some cases, suggests the potential benefit of antifibrinolytics; however, these have been little studied in this context. This study aimed to evaluate the effectiveness of combining tranexamic acid and antivenom in treating hemorrhagic syndrome and coagulopathy associated with Echis ocellatus (West African Carpet Viper) envenomation.
MATERIALS AND METHODS: Patients presenting with hemorrhagic syndrome due to envenomation were prospectively included at the Saint Jean de Dieu Hospital in Tanguiéta, Benin. Patients were randomized into two groups: one receiving antivenom and tranexamic acid (SAV + AT) and one receiving only antivenom (SAV). All patients received two vials of InoserpTM PAN-AFRICA antivenom upon admission. The SAV + AT group received 1 g of tranexamic acid over 30 minutes, followed by an additional 1 g over 8 hours. The occurrence of bleeding and the results of blood coagulation tests (whole blood clotting test or WBCT) were recorded at 2, 4, 6, 8, 12, 24, 48, and 72 hours after the initial antivenom administration. Antivenom administration was repeated if bleeding occurred at any of these times. The INR (International Normalized Ratio) was measured at six and twelve hours. Tolerance was assessed at 1, 2, 4, 6, 8, 12, 24, 48, and 72 hours. Plasma creatinine was measured at 24 and 72 hours.
RESULTS: Twenty-five patients were included: Twelve patients were in the SAV + AT group, and thirteen patients were in the SAV group. Six patients in the SAV + AT group and five patients in the SAV group experienced persistent or recurrent bleeding (p = 0.695). There was no significant difference in WBCT at different time points between the two groups, nor in INR at 6 and 12 hours. There were no adverse effects suggesting intolerance to tranexamic acid (e.g., ocular abnormality, convulsions, or thrombosis), and plasma creatinine levels did not differ significantly between the two groups.
CONCLUSION: Systematic use of tranexamic acid showed no benefit for hemorrhagic syndrome and coagulopathy associated with E. ocellatus in Benin. Therefore, the indications for this adjunctive treatment need to be clarified.
MATERIALS AND METHODS: Patients presenting with hemorrhagic syndrome due to envenomation were prospectively included at the Saint Jean de Dieu Hospital in Tanguiéta, Benin. Patients were randomized into two groups: one receiving antivenom and tranexamic acid (SAV + AT) and one receiving only antivenom (SAV). All patients received two vials of InoserpTM PAN-AFRICA antivenom upon admission. The SAV + AT group received 1 g of tranexamic acid over 30 minutes, followed by an additional 1 g over 8 hours. The occurrence of bleeding and the results of blood coagulation tests (whole blood clotting test or WBCT) were recorded at 2, 4, 6, 8, 12, 24, 48, and 72 hours after the initial antivenom administration. Antivenom administration was repeated if bleeding occurred at any of these times. The INR (International Normalized Ratio) was measured at six and twelve hours. Tolerance was assessed at 1, 2, 4, 6, 8, 12, 24, 48, and 72 hours. Plasma creatinine was measured at 24 and 72 hours.
RESULTS: Twenty-five patients were included: Twelve patients were in the SAV + AT group, and thirteen patients were in the SAV group. Six patients in the SAV + AT group and five patients in the SAV group experienced persistent or recurrent bleeding (p = 0.695). There was no significant difference in WBCT at different time points between the two groups, nor in INR at 6 and 12 hours. There were no adverse effects suggesting intolerance to tranexamic acid (e.g., ocular abnormality, convulsions, or thrombosis), and plasma creatinine levels did not differ significantly between the two groups.
CONCLUSION: Systematic use of tranexamic acid showed no benefit for hemorrhagic syndrome and coagulopathy associated with E. ocellatus in Benin. Therefore, the indications for this adjunctive treatment need to be clarified.