{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,23]],"date-time":"2026-10-23T20:27:34Z","timestamp":1792787254703,"version":"4.5.0"},"reference-count":8,"publisher":"BMJ","issue":"10","funder":[{"name":"Indian Council of Medical Research","award":["5\/4\/ 8-21\/2021-NCD-11"],"award-info":[{"award-number":["5\/4\/ 8-21\/2021-NCD-11"]}],"id":[{"id":"https:\/\/ror.org\/0492wrx28","id-type":"ROR","asserted-by":"crossref"}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Case Rep"],"accepted":{"date-parts":[[2026,9,28]]},"published-print":{"date-parts":[[2026,10]]},"abstract":"<jats:p>Snakebite-associated coagulopathy is usually attributed to venom-induced consumption of clotting factors, but underlying mechanisms may be heterogeneous and not reliably detected by conventional coagulation tests. A man in his late 40s presented early after Russell\u2019s viper envenomation with local signs and a prolonged bedside modified Lee and White clotting time despite normal prothrombin time and activated partial thromboplastin time. Given this discordance, rotational thromboelastometry (ROTEM) was performed at admission. Extrinsically activated thromboelastometry (EXTEM) demonstrated rapid and complete clot lysis, while tranexamic acid-modified antifibrinolytic thromboelastometry (t-APTEM) showed restoration of clot stability with inhibition of fibrinolysis, supporting a hyperfibrinolytic component.<\/jats:p>\n                  <jats:p>The patient was managed with antivenom and supportive care, including plasma transfusion, with subsequent resolution of coagulopathy and an uncomplicated recovery. This report establishes a diagnostic and mechanistic framework for systematic evaluation of fibrinolysis in snakebite-associated coagulopathy and highlights that the role of antifibrinolytic therapy requires further exploration in patients demonstrating evidence of hyperfibrinolysis.<\/jats:p>","DOI":"10.1136\/bcr-2026-272120","type":"journal-article","created":{"date-parts":[[2026,10,7]],"date-time":"2026-10-07T13:15:28Z","timestamp":1791378928000},"page":"e272120","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":0,"title":["In vitro correction of venom-induced coagulopathy in\n                    <i>Daboia russelii<\/i>\n                    envenomation demonstrated using tranexamic acid-modified rotational thromboelastometry"],"prefix":"10.1136","volume":"19","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-3885-7822","authenticated-orcid":false,"given":"Aboobacker Mohamed","family":"Rafi","sequence":"first","affiliation":[{"name":"Department of Transfusion Medicine, Jubilee Mission Medical College and Research Institute, Thrissur, Kerala, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7347-802X","authenticated-orcid":false,"given":"Siju V","family":"Abraham","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine, Jubilee Mission Medical College Hospital and Research Institute, Thrissur, Kerala, India"},{"name":"Snakebite Life Support (SBLS), Jubilee Mission Medical College Hospital and Research Institute, Thrissur, Kerala, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Susheela J","family":"Innah","sequence":"additional","affiliation":[{"name":"Department of Transfusion Medicine, Jubilee Mission Medical College and Research Institute, Thrissur, Kerala, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Punchalil Chathappan","family":"Rajeev","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine, Jubilee Mission Medical College Hospital and Research Institute, Thrissur, Kerala, India"},{"name":"Snakebite Life Support (SBLS), Jubilee Mission Medical College Hospital and Research Institute, Thrissur, Kerala, India"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2026,10,7]]},"reference":[{"key":"2026100706151946000_19.10.e272120.1","doi-asserted-by":"crossref","DOI":"10.7554\/eLife.54076","article-title":"Trends in snakebite deaths in India from 2000 to 2019 in a nationally representative mortality study","volume":"9","author":"Suraweera","year":"2020","journal-title":"Elife"},{"key":"2026100706151946000_19.10.e272120.2","doi-asserted-by":"crossref","DOI":"10.1016\/j.lansea.2025.100598","article-title":"Clinical challenges, controversies, and regional strategies in snakebite care in India","volume":"37","author":"Abraham","year":"2025","journal-title":"Lancet Reg Health Southeast Asia"},{"key":"2026100706151946000_19.10.e272120.3","doi-asserted-by":"crossref","DOI":"10.3390\/toxins8100284","article-title":"Metalloproteases Affecting Blood Coagulation, Fibrinolysis and Platelet Aggregation from Snake Venoms: Definition and Nomenclature of Interaction Sites","volume":"8","author":"Kini","year":"2016","journal-title":"Toxins (Basel)"},{"key":"2026100706151946000_19.10.e272120.4","doi-asserted-by":"crossref","first-page":"211","DOI":"10.4103\/JETS.JETS_43_17","article-title":"Utility of Clot Waveform Analysis in Russell\u2019s Viper Bite Victims with Hematotoxicity","volume":"11","author":"Abraham","year":"2018","journal-title":"J Emerg Trauma Shock"},{"key":"2026100706151946000_19.10.e272120.5","doi-asserted-by":"crossref","first-page":"470","DOI":"10.1016\/j.wem.2020.08.003","article-title":"Hematotoxic Snakebite Victim with Trauma: The Role of Guided Transfusion, Rotational Thromboelastometry, and Tranexamic Acid","volume":"31","author":"Abraham","year":"2020","journal-title":"Wilderness Environ Med"},{"key":"2026100706151946000_19.10.e272120.6","doi-asserted-by":"crossref","DOI":"10.1590\/1678-9199-jvatitd-2022-0088","article-title":"Comparing modified Lee and White method against 20-minute whole blood clotting test as bedside coagulation screening test in snake envenomation victims","volume":"29","author":"Suseel","year":"2023","journal-title":"J Venom Anim Toxins Incl Trop Dis"},{"key":"2026100706151946000_19.10.e272120.7","unstructured":"National action plan for prevention and control of snakebite envenoming (NAPSE). 2024. Available: https:\/\/ncdc.mohfw.gov.in\/wp-content\/uploads\/2024\/07\/NATIONAL-ACTION-PLAN-FOR-PREVENTION-AND-CONTROL-OF-SNAKEBITE-ENVENOMING-NAPSE.pdf"},{"key":"2026100706151946000_19.10.e272120.8","doi-asserted-by":"crossref","first-page":"717","DOI":"10.1080\/15563650.2025.2528992","article-title":"Role of peripheral blood smear in identifying thrombotic microangiopathy in snakebites with venom-induced consumption coagulopathy","volume":"63","author":"Joseph Tomy","year":"2025","journal-title":"Clin Toxicol"}],"container-title":["BMJ Case Reports"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bcr-2026-272120","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,10,7]],"date-time":"2026-10-07T13:15:31Z","timestamp":1791378931000},"score":1,"resource":{"primary":{"URL":"https:\/\/casereports.bmj.com\/lookup\/doi\/10.1136\/bcr-2026-272120"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,10]]},"references-count":8,"journal-issue":{"issue":"10","published-online":{"date-parts":[[2026,10,7]]},"published-print":{"date-parts":[[2026,10]]}},"alternative-id":["10.1136\/bcr-2026-272120"],"URL":"https:\/\/doi.org\/10.1136\/bcr-2026-272120","relation":{},"ISSN":["1757-790X"],"issn-type":[{"value":"1757-790X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,10]]}}}