ORIGINAL RESEARCH article
Front. Med.
Sec. Hematology
This article is part of the Research TopicAdvancing Knowledge and Treatment of Snakebite EnvenomingView all articles
Fibrinogen Supplementation Enhances Antivenom Efficacy in Treating Coagulopathy due to Hemotoxic Snakebite Envenoming by Trimeresurus and Agkistrodon Species in Yunnan, China
Provisionally accepted
- The First People’s Hospital of Yunnan Province, Kunming, China
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Background: Timely administration of antivenom remains the cornerstone of treatment for hemotoxic snakebite envenoming, primarily aimed at neutralizing circulating toxins and halting the progression of venom-induced consumption coagulopathy (VICC), thus facilitating gradual recovery of the hemostatic system. However, immediate access to antivenom is not always possible, and variations in venom composition among snake species, along with individual patient differences, can result in significant morbidity (including persistent complications of coagulopathy) and mortality. Methods: This retrospective study evaluated 116 cases of hemotoxic snakebite envenoming caused by Trimeresurus stejnegeri, T. mucrosquamatus, and Agkistrodon halys at three hospitals in Yunnan Province, China. Among these, thirty-three patients consented to receive adjunctive therapy with fibrinogen (Fg) in addition to standard antivenom treatment, while the remaining 83 received antivenom alone. Coagulation parameters were measured at admission and discharge. Results: In the antivenom-only group, significant reductions were observed in prothrombin time (PT), international normalized ratio (INR), activated partial thromboplastin time (APTT), and D-dimer (DD2) levels (all P < 0.05), accompanied by increases in Fg and fibrin degradation products (FDP) (P < 0.05). Patients receiving the combined regimen demonstrated decreases in PT, INR, thrombin time (TT), APTT, FDP, and DD2 (all P < 0.05), along with a significant rise in Fg levels (P < 0.05). Those who received Fg presented with more severe coagulation deficits at baseline. Despite this, by the time of discharge, the median Fg level in the combination group [1.94 (1.52–2.20) g/L] was significantly higher than in the antivenom-only group [0.84 (0.68–1.17) g/L] (P < 0.0001), and closer to the physiological range (2–4 g/L). Moreover, the hospital stay in the combination group (4.88±1.47 days) was significantly shorter than in the antivenom-only group (7.07±2.02 days) (P < 0.0001). Conclusions: These findings suggest that adjunctive Fg supplementation may improve the laboratory parameters of coagulopathy and reduce the length of hospital stay in hemotoxic snakebite envenoming. However, further clinical evaluations are needed to support the use of Fg as an adjuvant in the management of hemotoxic snakebite envenoming.
Keywords: Snake bite, Fibrinogen, Coagulation function, Antivenom, Hemotoxin
Received: 17 Jul 2025; Accepted: 02 Dec 2025.
Copyright: © 2025 Gao, Wang, Yajun, Huang, Wang, Feng, Han and Li. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: Zengzheng Li
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