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Toxins 2019, 11(1), 22; https://doi.org/10.3390/toxins11010022

Factors Associated with Systemic Bleeding in Bothrops Envenomation in a Tertiary Hospital in the Brazilian Amazon

1
Escola Superior de Ciências da Saúde, Universidade do Estado do Amazonas, Manaus 69065-001, Brazil
2
Instituto de Pesquisa Clínica Carlos Borborema, Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus 69040-000, Brazil
3
Laboratório de Fisiopatologia, Instituto Butantan, São Paulo 05503-900, Brazil
These authors contributed equally to this work.
*
Author to whom correspondence should be addressed.
Received: 11 November 2018 / Revised: 14 December 2018 / Accepted: 20 December 2018 / Published: 7 January 2019
(This article belongs to the Section Animal Venoms)
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Abstract

Bothrops snakebites usually present systemic bleeding, and the clinical–epidemiological and laboratorial factors associated with the development of this manifestation are not well established. In this study, we assessed the prevalence of Bothrops snakebites with systemic bleeding reported at the Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, in Manaus, Amazonas State, Brazil, and the clinical–epidemiological and laboratorial factors associated with systemic bleeding. This is an observational, cross-sectional study carried out between August, 2013 and July, 2016. Patients who developed systemic bleeding on admission or during hospitalization were considered cases, and those with non-systemic bleeding were included in the control group. Systemic bleeding was observed in 63 (15.3%) of the 442 Bothrops snakebites evaluated. Bothrops snakebites mostly occurred in males (78.2%), in rural areas (89.0%) and in the age group of 11 to 30 years old (40.4%). It took most of the patients (59.8%) less than 3 h to receive medical assistance. Unclottable blood (AOR = 3.11 (95% CI = 1.53 to 6.31; p = 0.002)) and thrombocytopenia (AOR = 4.52 (95% CI = 2.03 to 10.09; p < 0.001)) on admission were independently associated with systemic bleeding during hospitalization. These hemostatic disorders on admission increase the chances of systemic bleeding during hospitalization. Prospective studies are needed to clarify the pathophysiology of systemic bleeding in Bothrops snakebites in the Amazon region. View Full-Text
Keywords: hemostatic disorders; unclottable blood; thrombocytopenia; Bothrops atrox hemostatic disorders; unclottable blood; thrombocytopenia; Bothrops atrox
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Oliveira, S.S.; Alves, E.C.; Santos, A.S.; Pereira, J.P.T.; Sarraff, L.K.S.; Nascimento, E.F.; De-Brito-Sousa, J.D.; Sampaio, V.S.; Lacerda, M.V.; Sachett, J.A.; Sano-Martins, I.S.; Monteiro, W.M. Factors Associated with Systemic Bleeding in Bothrops Envenomation in a Tertiary Hospital in the Brazilian Amazon. Toxins 2019, 11, 22.

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