Point-of-care derived INR does not reliably detect significant coagulopathy following Australian snakebite

Kacey M O'Rourke, Elizabeth Correlje, Cameron L. Martin, Jeremy D. Robertson, Geoffrey K. Isbister

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6 Citations (Scopus)

Abstract

Introduction Point-of-care international normalised ratio (INR) has been suggested as a way to screen for venom-induced consumption coagulopathy following snakebite, but has not been validated for this. This study aimed to assess the diagnostic reliability of point-of-care INR for venom-induced consumption coagulopathy. Methods This was a prospective study of snakebite patients recruited between January 2011 and May 2012 where a point-of-care INR was done and compared to an INR done on a laboratory coagulation analyser, as part of a quality assurance exercise. Data was obtained for each patient, including demographics, information on the snake bite, the point-of-care INR results and any laboratory derived coagulation studies. Snake identification was confirmed by expert identification or venom specific enzyme immunoassay. Results There were 15 patients with a median age of 29 years (2 to 68y) and 13 were male. Four of the 7 patients with venom-induced consumption coagulopathy had an abnormal point-of-care INR (3 false negatives) and 1 of the 7 non-envenomed patients had an abnormal point-of-care INR (1 false positive). The patient with a falsely elevated point-of-care INR was given antivenom prior to formal coagulation studies. The point-of-care INR was also negative in the patient with an anticoagulant coagulopathy. Conclusions The study shows that point-of-care INR testing devices should not be used in suspected snakebite cases in Australia to diagnose venom-induced consumption coagulopathy.

Original languageEnglish
Pages (from-to)610-613
Number of pages4
JournalThrombosis Research
Volume132
Issue number5
DOIs
Publication statusPublished - Nov 2013
Externally publishedYes

Keywords

  • Coagulopathy
  • Diagnostic tests
  • Envenomation
  • INR
  • Point-of-care testing
  • Snakebite

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