Boomslang (Dispholidus typus) envenomation in a patient on warfarin therapy

S Afr Med J. 2020 Sep 30;110(10):999-1002. doi: 10.7196/SAMJ.2020.v110i10.15137.

Abstract

The venom of the boomslang (Dispholidus typus) has potent effects on the coagulation system. It is known to produce a venom-induced consumptive coagulopathy (VICC) through the proposed activation of clotting factor II (prothrombin), factor X, and possibly factor IX. Warfarin, an anticoagulant medication, decreases the circulating vitamin K-dependent clotting factors II, VII, IX and X. We report a unique case of a boomslang bite in a patient on warfarin therapy. During the patient's hospital stay he developed abnormal clotting profiles indicating an underlying VICC, but without major bleeding. He received monovalent antivenom and recovered with no complications. We discuss two possible outcomes of a boomslang bite in a patient on warfarin therapy, exploring the underlying pathophysiology that could lead to the presentation of a reduced risk of overall bleeding or, alternatively, that the bleeding could be compounded and exacerbated. It is possible that in our case the anticoagulant effect of warfarin was wholly obscured by the VICC of the boomslang venom. The composition of the snake venom may have been a contributory factor in the reduced clinical bleeding observed.

Publication types

  • Case Reports

MeSH terms

  • Anticoagulants / pharmacology*
  • Anticoagulants / therapeutic use
  • Antivenins / pharmacology*
  • Antivenins / therapeutic use
  • Blood Coagulation / drug effects*
  • Blood Coagulation Disorders / etiology
  • Blood Coagulation Disorders / physiopathology
  • Drug Interactions
  • Humans
  • Male
  • Middle Aged
  • Snake Bites / drug therapy*
  • Snake Bites / physiopathology*
  • Snake Venoms / adverse effects
  • Snake Venoms / pharmacology*
  • Warfarin / pharmacology*
  • Warfarin / therapeutic use

Substances

  • Anticoagulants
  • Antivenins
  • Snake Venoms
  • Warfarin