It is clear from these

reports that, in some patients, defibrination and/or thrombocytopenia do not respond to large doses of FabAV. However, based on the observation that no reports describe medically significant bleeding that began after FabAV administration, the risk of bleeding in this situation is probably low. Subsequent to this structured literature review, a case report of fatal cerebral hemorrhage associated with recurrent defibrination in a FabAV-treated patient has been reported[44]. The authors of this report could find no other cases of significant spontaneous bleeding Inhibitors,research,lifescience,medical in 34 published cases of recurrent coagulopathy. A large cohort study of FabAV-treated patients, followed to resolution with detailed biochemical characterization including venom antigenemia, would Inhibitors,research,lifescience,medical be valuable to selleck products address this important question. Until that time, the recommendations made by Yip continue to represent the best available guidance in this area, with the caveat that, beyond a certain point, administration of additional FabAV to patients with refractory hemostatic dysfunction is unlikely to be beneficial[8]. The recommended dosing of FabAV is 4- to 6-vial aliquots, repeated as needed until the desired clinical effect is achieved. In the premarketing studies of

mild and moderately Inhibitors,research,lifescience,medical envenomated patients, the median dose of FabAV used to achieve initial control of the envenomation syndrome Inhibitors,research,lifescience,medical was 6 vials (range: 3 to 12 vials)[4,5]. In this review of severely envenomated patients, initial control of severe venom effects was achieved after a median dose of 6 vials (range: 4 to 18 vials) was administered. Some patients received extraordinary doses in response to persistent or recurrent severe venom effects; whether

patients benefited from doses in excess of 18 vials, excluding maintenance therapy, Inhibitors,research,lifescience,medical is unclear. The NPDS contains information about 15,917 crotaline snake envenomations treated in a health care facility from 2000 to 2006; 21 of these Farnesyltransferase patients (0.13%) died. Five fatality reports describe death that occurred after FabAV administration; another two patients received unspecified antivenom prior to death. No deaths appear to be caused by an adverse reaction to FabAV. Although it is difficult to make broad conclusions based on the sparse descriptions in these reports, the lack of any clear cases of treatment-failure associated death is reassuring. The fact that the fatal case reported by Kitchens and Eskin did not appear in the NPDS reports underscores one weakness of US poison-center based data, which rely on voluntary reporting[44]. In addition to issues surrounding retrospective data collection and publication bias, this report is limited by the lack of a comparison group.