In vitro correction of venom-induced coagulopathy in Daboia russelii envenomation demonstrated using tranexamic acid-modified rotational thromboelastometry.

Snakebite-associated coagulopathy is usually attributed to venom-induced consumption of clotting factors, but underlying mechanisms may be heterogeneous and not reliably detected by conventional coagulation tests. A man in his late 40s presented early after Russell's viper envenomation with local signs and a prolonged bedside modified Lee and White clotting time despite normal prothrombin time and activated partial thromboplastin time. Given this discordance, rotational thromboelastometry (ROTEM) was performed at admission. Extrinsically activated thromboelastometry (EXTEM) demonstrated rapid and complete clot lysis, while tranexamic acid-modified antifibrinolytic thromboelastometry (t-APTEM) showed restoration of clot stability with inhibition of fibrinolysis, supporting a hyperfibrinolytic component.The patient was managed with antivenom and supportive care, including plasma transfusion, with subsequent resolution of coagulopathy and an uncomplicated recovery. This report establishes a diagnostic and mechanistic framework for systematic evaluation of fibrinolysis in snakebite-associated coagulopathy and highlights that the role of antifibrinolytic therapy requires further exploration in patients demonstrating evidence of hyperfibrinolysis.