Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2024 Mar 13;16(3):146.
doi: 10.3390/toxins16030146.

Bothrops lanceolatus Envenoming in Martinique: A Historical Perspective of the Clinical Effectiveness of Bothrofav Antivenom Treatment

Dabor Resiere  1   2 , Jonathan Florentin  1   2 , Hossein Mehdaoui  1   2 , Hatem Kallel  3 , Veronique Legris-Allusson  4 , Papa Gueye  1   2 , Remi Neviere  1   2
Affiliations

Bothrops lanceolatus Envenoming in Martinique: A Historical Perspective of the Clinical Effectiveness of Bothrofav Antivenom Treatment

Dabor Resiere et al. Toxins (Basel). .

Abstract

Bothrofav, a monospecific antivenom, was introduced in June 1991 and has shown excellent effectiveness against life-threatening and thrombotic complications of Bothrops lanceolatus envenoming. Because of the reoccurrence of cerebral stroke events despite the timely administration of antivenom, new batches of Bothrofav were produced and introduced into clinical use in January 2011. This study's aim was to evaluate the effectiveness of Bothrofav generations at treating B. lanceolatus envenoming. During the first period of the study (2000-2010), 107 patients were treated with vials of antivenom produced in June 1991, while 282 envenomed patients were treated with vials of antivenom produced in January 2011 in the second study period (2011-2023). Despite timely antivenom administration, thrombotic complications reoccurred after an interval free of thrombotic events, and a timeframe analysis suggested that the clinical efficacy of Bothrofav declined after it reached its 10-year shelf-life. In of the case of an antivenom shortage due to the absence of regular batch production, no adverse effects were identified before the antivenom reached its 10-year shelf-life, which is beyond the accepted shelf-life for a liquid-formulation antivenom. While our study does not support the use of expired antivenom for potent, life-threatening B. lanceolatus envenoming, it can be a scientific message to public entities proving the necessity of new antivenom production for B. lanceolatus envenoming.

Keywords: Bothrofav; Bothrops lanceolatus; antivenom shortage; efficacy; envenoming; snakebite; thrombosis.

PubMed Disclaimer

Conflict of interest statement

The authors declare no conflicts of interest. The funders had no role in the design of the study; in the collection, analyses, or interpretation of data; in the writing of the manuscript; or in the decision to publish the results.

Figures

Figure 1
Figure 1
Absolute number of cerebral thrombotic events associated with timely treatment of B. lanceolatus envenoming using Bothrofav according to protocol. Timeline is presented as 3-year tick intervals.
See this image and copyright information in PMC

References

    1. Gutierrez J.M., Calvete J.J., Habib A.G., Harrison R.A., Williams D.J., Warrell D.A. Snakebite envenoming. Nat. Rev. Dis. Primers. 2017;3:17063. doi: 10.1038/nrdp.2017.63. - DOI - PubMed
    1. Cavalcante J.S., de Almeida D.E.G., Santos-Filho N.A., Sartim M.A., Baldo A.d.A., Brasileiro L., Albuquerque P.L., Oliveira S.S., Sachett J.A.G., Monteiro W.M., et al. Crosstalk of inflammation and coagulation in Bothrops snakebite envenoming: Endogenous signaling pathways and pathophysiology. Int. J. Mol. Sci. 2023;24:11508. doi: 10.3390/ijms241411508. - DOI - PMC - PubMed
    1. Moore G.W. Snake venoms in diagnostic hemostasis and thrombosis. Semin. Thromb. Hemost. 2022;48:145–160. doi: 10.1055/s-0041-1732465. - DOI - PubMed
    1. Monteiro W.M., Contreras-Bernal J.C., Bisneto P.F., Sachett J., Da Silva I.M., Lacerda M., Da Costa A.G., Val F., Brasileiro L., Sartim M.A., et al. Bothrops atrox, the most important snake involved in human envenomings in the Amazon: How venomics contributes to the knowledge of snake biology and clinical toxinology. Toxicon X. 2020;6:100037. doi: 10.1016/j.toxcx.2020.100037. - DOI - PMC - PubMed
    1. Gutiérrez J.M., Sanz L., Escolano J., Fernández J., Lomonte B., Angulo Y., Rucavado A., Warrell D.A., Calvete J.J. Snake venomics of the Lesser Antillean pit vipers Bothrops caribbaeus and Bothrops lanceolatus: Correlation with toxicological activities and immunoreactivity of a het-erologous antivenom. J. Proteome Res. 2008;7:4396–4408. doi: 10.1021/pr8003826. - DOI - PubMed

Publication types

Supplementary concepts

LinkOut - more resources