Low Molecular Weight Heparin in Viper Bite

(Trial Of Low Molecular Weight Heparin in the Treatment of Viper Bites: Paul V, Pudoor A et al. Journal of the Association of Physicians of India JAPI, Volume 55, May 2007)

Q. Should Low Molecular Weight Heparin (LMWH) be used in Viper Snake Bites ?

Yes. Viper venom is hematotoxic and increase the bleeding tendency yet LMWH which also increase bleeding tendencies is used in Viper Snake bite ! This is because one of the biggest problems with Viper snake bite is that it causes DIC (Disseminated Intravascular Coagulation), LMWH prevents DIC. Hence it is logical to use Heparin in Viper Snake bites. A study done by Paul, Pudor et al published in May 2007 in JAPI proves this to be true. They found it LMWH reduces the mortality and morbidity in patients with Viper bites.

Q. What are the two leading cause of death in patient with Viper bite ?

Hypotension and Acute Renal Failure are the two leading causes of death in patient with Viper Bite, both of which can be caused by DIC.

Q. Where does LMWH act ?

LMWH acts on Factor Xa in coagulation cycle

Q. What are the advantages and Disdvantages of LMWH over Unfractionated Heparin ?

LMWH has less chances of severe bleeding episodes than unfractionated heparin. Also it has better absorption through subcutaneous route and has not effect on platelets.Also LMWH does cause Nitrous oxide (NO) release from the vascular endothelium which is the culprit in causing hypotension.

The biggest drawback of using LMWH in viper bite patient compared to UFH (other than the cost which is substantially high for LMWH) is that it doesn’t prevent microvascular thrombosis which is an important cause of Renal failure in such patients. This is what they found in the study. LMWH couldn’t prevent renal failure like UFH could.

Conclusion : It is a good Idea to Use Low Molecular Weight heparin in patients with Viper Snake Bite.