{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,12,12]],"date-time":"2025-12-12T13:43:03Z","timestamp":1765546983474,"version":"3.38.0"},"reference-count":21,"publisher":"SAGE Publications","issue":"4","license":[{"start":{"date-parts":[[2022,12,1]],"date-time":"2022-12-01T00:00:00Z","timestamp":1669852800000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Wilderness &amp; Environmental Medicine"],"published-print":{"date-parts":[[2022,12]]},"abstract":"<jats:sec><jats:title>Introduction<\/jats:title><jats:p> The green pit viper (GPV) Trimeresurus albolabris is found in Southeast Asia. Its venom has a thrombin-like activity that can cause hypofibrinogenemia. Fibrinogen measurement is not always available. We aimed to establish a more available diagnostic tool indicating hypofibrinogenemia caused by GPV envenomation. <\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p> This was an in vitro study, in which healthy subjects aged 20 to 45 y were enrolled. There were 2 experiments. In Experiment 1, blood samples from 1 subject had varying amounts of T albolabris venom added to determine its effect on the fibrinogen level (FL). In Experiment 2, 3 sets of blood samples were obtained from another 25 subjects. The 2 venom doses established in Experiment 1 were used on 2 sets of the samples to simulate severe (FL &lt;1.0 g\u00b7L<jats:sup>\u22121<\/jats:sup>) and mild hypofibrinogenemia (FL 1.0\u20131.7 g\u00b7L<jats:sup>\u22121<\/jats:sup>). The third set of samples was venom-free. All samples were used for platelet counts, prothrombin time (PT)\/international normalized ratio (INR)\/activated partial thromboplastin time (aPTT), and 2 bedside clotting tests. Diagnostic parameters were calculated against the target FL of &lt;1.0 g\u00b7L<jats:sup>\u22121<\/jats:sup> and &lt;1.7 g\u00b7L<jats:sup>\u22121<\/jats:sup>. <\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p> Twenty-five subjects were enrolled in Experiment 2. On referencing normal cutoff values (platelet count &gt;150,000 cells\/mm<jats:sup>3<\/jats:sup>, venous clotting time &lt;15 min, normal 20-min whole blood clotting time, INR &lt;1.2, aPTT &lt;30), we found abnormalities of 5, 0, 0, 3, and 22%, respectively. The highest correlation with hypofibrinogenemia was provided by PT\/INR. For an FL of &lt;1.0 g\u00b7L<jats:sup>\u22121<\/jats:sup>, PT and INR revealed the highest areas under the receiver operating characteristic curve, 0.76 (95% CI, 0.55\u20130.97) and 0.76 (95% CI, 0.57\u20130.97), respectively. The highest accuracy and the highest sensitivity were provided by PT\/INR. <\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p> PT\/INR could be used as a diagnostic test for severe hypofibrinogenemia in GPV envenomation because of its high accuracy and area under the receiver operating characteristic curve. <\/jats:p><\/jats:sec>","DOI":"10.1016\/j.wem.2022.07.011","type":"journal-article","created":{"date-parts":[[2022,10,8]],"date-time":"2022-10-08T02:19:27Z","timestamp":1665195567000},"page":"371-378","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":1,"title":["Diagnostic Tests for Hypofibrinogenemia Resulting from Green Pit Viper (<i>Trimeresurus albolabris<\/i>) Envenomation: A Simulated In Vitro Study"],"prefix":"10.1177","volume":"33","author":[{"given":"Gawin","family":"Tiyawat","sequence":"first","affiliation":[{"name":"Department of Disaster and Emergency Medical Operation, Faculty of Sciences and Health Technology, Navamindradhiraj University, Bangkok, Thailand"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sirin","family":"Lohajaroensub","sequence":"additional","affiliation":[{"name":"Pathumthani University, Pathum Thani, Thailand"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Rittirak","family":"Othong","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine, Faculty of Medicine Vajira Hospital, Navamindradhiraj University, Bangkok, Thailand"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"179","published-online":{"date-parts":[[2022,12,1]]},"reference":[{"key":"bibr1-j.wem.2022.07.011","doi-asserted-by":"publisher","DOI":"10.1258\/004947507782332838"},{"key":"bibr2-j.wem.2022.07.011","doi-asserted-by":"publisher","DOI":"10.1080\/15563650.2019.1708090"},{"key":"bibr3-j.wem.2022.07.011","doi-asserted-by":"publisher","DOI":"10.1016\/j.toxlet.2019.09.003"},{"key":"bibr4-j.wem.2022.07.011","doi-asserted-by":"publisher","DOI":"10.1016\/j.actatropica.2020.105528"},{"key":"bibr5-j.wem.2022.07.011","doi-asserted-by":"publisher","DOI":"10.4269\/ajtmh.1998.58.22"},{"key":"bibr6-j.wem.2022.07.011","doi-asserted-by":"publisher","DOI":"10.3109\/15569543.2013.852109"},{"issue":"11","key":"bibr7-j.wem.2022.07.011","first-page":"275","volume":"6","author":"Pradniwat P.","year":"2014","journal-title":"J\u00a0Chem Pharm Res"},{"key":"bibr8-j.wem.2022.07.011","doi-asserted-by":"publisher","DOI":"10.1016\/j.cbpb.2011.09.009"},{"key":"bibr9-j.wem.2022.07.011","doi-asserted-by":"publisher","DOI":"10.1016\/S0041-0101(98)00214-1"},{"issue":"6","key":"bibr10-j.wem.2022.07.011","first-page":"795","volume":"6","author":"Rojnuckarin P.","year":"2012","journal-title":"Asian Biomed"},{"key":"bibr11-j.wem.2022.07.011","unstructured":"Guidelines for the Management of Snakebites 2nd ed. New Delhi, India: Publishing and Sales, World Health Organization, 2016."},{"key":"bibr12-j.wem.2022.07.011","unstructured":"Department of Medical Services, Ministry of Public Health. Practice guideline for management of patients with snake bite. Available at: https:\/\/www.scribd.com\/document\/382171851\/snake-pdf. 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