Background: Snakebite envenomation is a significant global health concern associated with substantial morbidity and mortality, particularly due to hematologic and coagulation disturbances. Venom-induced coagulopathy and other systemic effects may persist despite antivenom therapy, and the temporal pattern of laboratory recovery remains incompletely understood. This study aimed to evaluate clinical features and longitudinal hematologic and coagulation changes following antivenom administration in patients with snakebite envenomation.
Methods: This retrospective observational study included 154 patients with confirmed snakebite envenomation admitted to a tertiary care center between 2016 and 2022. Demographic data, clinical manifestations, treatment characteristics, and laboratory parameters were extracted from medical records. Hematologic and coagulation indices included white blood cell count, hemoglobin, platelet count, prothrombin time (PT), international normalized ratio (INR), and activated partial thromboplastin time (aPTT). Patients were analyzed in full, paired (pre- and post-antivenom), and longitudinal groups. Statistical analyses included paired t tests, Wilcoxon signed-rank tests, and repeated-measures ANOVA.
Results: The mean age was 37.5 ± 17.2 years, and 77.3% were male. Most bites involved the lower extremities (64.9%). Grade 1 envenomation accounted for 55.2% of cases, while 44.8% had Grade ≥2. Local manifestations were predominant. Hemoglobin levels significantly decreased after antivenom administration (P < 0.001), while no immediate changes were observed in coagulation parameters. Longitudinal analysis showed a significant decline in white blood cell count and gradual improvement in PT and INR during hospitalization (P < 0.05).
Conclusion: Snakebite envenomation is characterized by predominant local effects with dynamic hematologic alterations during hospitalization. Coagulation recovery appears gradual rather than immediately following antivenom therapy, emphasizing the importance of serial laboratory monitoring.
Implications for Patient Care: Continuous monitoring of hematologic and coagulation parameters is recommended even after antivenom administration. Serial assessment may improve early detection of ongoing or delayed coagulopathy and support informed clinical decision-making in inpatient management of snakebite envenomation.