{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,20]],"date-time":"2026-03-20T18:58:25Z","timestamp":1774033105854,"version":"3.50.1"},"update-to":[{"DOI":"10.1371\/journal.pntd.0014121","type":"new_version","label":"New version","source":"publisher","updated":{"date-parts":[[2026,3,20]],"date-time":"2026-03-20T00:00:00Z","timestamp":1773964800000}}],"reference-count":37,"publisher":"Public Library of Science (PLoS)","issue":"3","license":[{"start":{"date-parts":[[2026,3,16]],"date-time":"2026-03-16T00:00:00Z","timestamp":1773619200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Navamindradhiraj University Research Funds","award":["030\/2566"],"award-info":[{"award-number":["030\/2566"]}]}],"content-domain":{"domain":["www.plosntds.org"],"crossmark-restriction":false},"short-container-title":["PLoS Negl Trop Dis"],"abstract":"<jats:sec id=\"sec001\">\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>The 20-minute whole blood clotting test (20WBCT) is widely used in patients with viper envenomation in resource-limited settings. The unclotted result guides the need for antivenom administration. Confusion has arisen on how to interpret \u201cpartially clotted\u201d for the test due to a paucity of data. This study\u2019s primary aim was to evaluate the association between fibrinogen concentrations (FC) and states of clotting from the 20WBCT in green pit viper (GPV) envenomation.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec002\">\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Patients aged \u226518 years who presented to our hospital with GPV bites were enrolled between September 2022 and November 2023. All 20WBCT were done by laboratory technicians and the results were video recorded. Corresponding blood samples were quantified for FC. Two investigators, blinded to clinical\/laboratory data, interpreted clotting results from recordings. A third investigator resolved conflicts.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec003\">\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Thirty-nine patients contributed 188 blood samples. 20WBCT results were categorized as completely clotted, partially clotted (subdivided into mostly or minimally clotted), or unclotted, with median FC of 259.1, 223.5, 226.1, and 48.7 mg\/dL, respectively. FC in the unclotted group were significantly lower than those in the other groups (completely: p\u2009=\u20090.001; mostly: p\u2009&lt;\u20090.001; minimally: p\u2009=\u20090.002), with no differences among the completely clotted and two subgroups of the partially clotted. The unclotted 20WBCT had 28.6% sensitivity and 99.4% specificity for detecting FC\u2009&lt;\u2009100 mg\/dL. Further analysis found that a FC\u2009&lt;\u200970 mg\/dL best predicted the unclotted result (the area under the receiver operating characteristic curve was 0.99 (0.99-1.0) and the accuracy was 98.9%).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec004\">\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Compared with the partially clotted samples (either mostly or minimally clotted), FC were significantly lower in the unclotted, but similar to the completely clotted samples. The partially clotted samples should be interpreted as completely clotted.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1371\/journal.pntd.0014121","type":"journal-article","created":{"date-parts":[[2026,3,16]],"date-time":"2026-03-16T17:29:20Z","timestamp":1773682160000},"page":"e0014121","update-policy":"https:\/\/doi.org\/10.1371\/journal.pntd.corrections_policy","source":"Crossref","is-referenced-by-count":0,"title":["Association between the 20-minute whole blood clotting test and fibrinogen concentrations in green pit viper envenomations in Bangkok"],"prefix":"10.1371","volume":"20","author":[{"given":"Supa","family":"Niruntarai","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sivilai","family":"Hengtrakul","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5926-353X","authenticated-orcid":true,"given":"Rittirak","family":"Othong","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"340","published-online":{"date-parts":[[2026,3,16]]},"reference":[{"key":"pntd.0014121.ref001"},{"issue":"9","key":"pntd.0014121.ref002","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pntd.0010775","article-title":"Estimating economic and disease burden of snakebite in ASEAN countries using a decision analytic model","volume":"16","author":"C Patikorn","year":"2022","journal-title":"PLoS Negl Trop Dis"},{"issue":"1","key":"pntd.0014121.ref003","doi-asserted-by":"crossref","first-page":"100","DOI":"10.1016\/0035-9203(92)90463-M","article-title":"A national hospital-based survey of snakes responsible for bites in Thailand","volume":"86","author":"C Viravan","year":"1992","journal-title":"Trans R Soc Trop Med Hyg"},{"key":"pntd.0014121.ref004","first-page":"214","article-title":"Snake bite envenoming.","volume-title":"Annual epidemiological surveillance report 2018","author":"S. Eakumpan","year":"2018"},{"issue":"2","key":"pntd.0014121.ref005","first-page":"225","article-title":"The species of green pit viper in Bangkok","volume":"21","author":"S Mahasandana","year":"1990","journal-title":"Southeast Asian J Trop Med Public Health"},{"issue":"5","key":"pntd.0014121.ref006","doi-asserted-by":"crossref","first-page":"318","DOI":"10.1093\/milmed\/163.5.318","article-title":"Venomous snakebite in Thailand. II: Clinical experience","volume":"163","author":"C Pochanugool","year":"1998","journal-title":"Mil Med"},{"issue":"6","key":"pntd.0014121.ref007","doi-asserted-by":"crossref","first-page":"866","DOI":"10.1016\/0035-9203(90)90111-Q","article-title":"Arboreal green pit vipers (genus Trimeresurus) of South-East Asia: bites by T. albolabris and T. macrops in Thailand and a review of the literature","volume":"84","author":"RA Hutton","year":"1990","journal-title":"Trans R Soc Trop Med Hyg"},{"issue":"4","key":"pntd.0014121.ref008","doi-asserted-by":"crossref","first-page":"515","DOI":"10.11646\/zootaxa.5357.4.3","article-title":"A new green pitviper of the Trimeresurus albolabris complex (Reptilia, Serpentes, Viperidae) from central and southern Myanmar","volume":"5357","author":"G Vogel","year":"2023","journal-title":"Zootaxa"},{"issue":"2","key":"pntd.0014121.ref009","doi-asserted-by":"crossref","first-page":"79","DOI":"10.1177\/102490791702400205","article-title":"Bamboo snake (Trimeresurus Albolabris) Bite in Hong Kong and its prognostic factors for local complications with surgical intervention, coagulopathy and thrombocytopenia","volume":"24","author":"P Suen","year":"2017","journal-title":"Hong Kong J Emerg Med"},{"key":"pntd.0014121.ref010","doi-asserted-by":"crossref","first-page":"266","DOI":"10.1016\/j.ympev.2015.06.001","article-title":"Convergence of multiple markers and analysis methods defines the genetic distinctiveness of cryptic pitvipers","volume":"92","author":"Mrinalini","year":"2015","journal-title":"Mol Phylogenet Evol"},{"issue":"8","key":"pntd.0014121.ref011","doi-asserted-by":"crossref","first-page":"1791","DOI":"10.1111\/j.1538-7836.2005.01358.x","article-title":"Snake venoms and hemostasis","volume":"3","author":"Q Lu","year":"2005","journal-title":"J Thromb Haemost"},{"key":"pntd.0014121.ref012","doi-asserted-by":"crossref","first-page":"16","DOI":"10.3109\/15569543.2013.852109","article-title":"Snake venom thrombin-like enzymes","volume":"33","author":"P Pradniwat","year":"2013","journal-title":"Toxin Rev"},{"issue":"5","key":"pntd.0014121.ref013","doi-asserted-by":"crossref","first-page":"743","DOI":"10.1016\/S0041-0101(98)00214-1","article-title":"The effects of green pit viper (Trimeresurus albolabris and Trimeresurus macrops) venom on the fibrinolytic system in human","volume":"37","author":"P Rojnuckarin","year":"1999","journal-title":"Toxicon"},{"issue":"5","key":"pntd.0014121.ref014","doi-asserted-by":"crossref","first-page":"1389","DOI":"10.1111\/trf.12431","article-title":"Fibrinogen as a therapeutic target for bleeding: a review of critical levels and replacement therapy","volume":"54","author":"JH Levy","year":"2014","journal-title":"Transfusion"},{"issue":"7","key":"pntd.0014121.ref015","doi-asserted-by":"crossref","first-page":"415","DOI":"10.1016\/j.trstmh.2012.04.003","article-title":"The role of prothrombin time (PT) in evaluating green pit viper (Cryptelytrops sp) bitten patients","volume":"106","author":"J Pongpit","year":"2012","journal-title":"Trans R Soc Trop Med Hyg"},{"key":"pntd.0014121.ref016","doi-asserted-by":"crossref","first-page":"2050312120966468","DOI":"10.1177\/2050312120966468","article-title":"Utility of thrombin time in management of patients with green pit vipers bite","volume":"8","author":"A Tongpoo","year":"2020","journal-title":"SAGE Open Med"},{"key":"pntd.0014121.ref017","first-page":"1","volume-title":"Guidelines for the management of snake-bites 2nd edition. World Health Organization","author":"WHO Regional Office for South-East Asia","year":"2016"},{"key":"pntd.0014121.ref018","doi-asserted-by":"crossref","first-page":"100079","DOI":"10.1016\/j.toxcx.2021.100079","article-title":"Clinical management of snakebite envenoming: future perspectives","volume":"11","author":"M Hamza","year":"2021","journal-title":"Toxicon X"},{"issue":"3","key":"pntd.0014121.ref019","first-page":"81","article-title":"Whole blood clotting time: variation of practice in coagulation laboratory, members of Thailand National External Quality Assessment Scheme","volume":"63","author":"P Wongkrajang","year":"2011","journal-title":"Siriraj Med J"},{"key":"pntd.0014121.ref020","doi-asserted-by":"crossref","first-page":"188","DOI":"10.1016\/j.toxicon.2020.07.020","article-title":"Sensitivity and specificity of 20-minute whole blood clotting test, prothrombin time, activated partial thromboplastin time tests in diagnosis of defibrination following Malayan pit viper envenoming","volume":"185","author":"N Thongtonyong","year":"2020","journal-title":"Toxicon"},{"issue":"6","key":"pntd.0014121.ref021","doi-asserted-by":"crossref","first-page":"1006","DOI":"10.1111\/1742-6723.13788","article-title":"Bacterial infection secondary to Trimeresurus species bites: a retrospective cohort study in a university hospital in Bangkok","volume":"33","author":"S Kriengkrairut","year":"2021","journal-title":"Emerg Med Australas"},{"issue":"9","key":"pntd.0014121.ref022","doi-asserted-by":"crossref","first-page":"893","DOI":"10.1080\/15563650.2019.1708090","article-title":"A study regarding follow-ups after green pit viper bites treated according to the practice guideline by the Ministry of Public Health of Thailand.","volume":"58","author":"R Othong","year":"2020","journal-title":"Clin Toxicol (Phila)"},{"key":"pntd.0014121.ref023","doi-asserted-by":"crossref","first-page":"14","DOI":"10.1186\/s40409-018-0151-1","article-title":"Delayed double reading of whole blood clotting test (WBCT) results at 20 and 30 minutes enhances diagnosis and treatment of viper envenomation","volume":"24","author":"JM Benjamin","year":"2018","journal-title":"J Venom Anim Toxins Incl Trop Dis"},{"issue":"9","key":"pntd.0014121.ref024","doi-asserted-by":"crossref","first-page":"583","DOI":"10.3390\/toxins12090583","article-title":"Bedside coagulation tests in diagnosing venom-induced consumption coagulopathy in snakebite","volume":"12","author":"S Wedasingha","year":"2020","journal-title":"Toxins (Basel)"},{"key":"pntd.0014121.ref025","doi-asserted-by":"crossref","first-page":"13","DOI":"10.1186\/1471-2288-5-13","article-title":"Estimating the mean and variance from the median, range, and the size of a sample","volume":"5","author":"SP Hozo","year":"2005","journal-title":"BMC Med Res Methodol"},{"issue":"23","key":"pntd.0014121.ref026","doi-asserted-by":"crossref","first-page":"2676","DOI":"10.1002\/sim.4509","article-title":"Classification accuracy and cut point\u2009selection","volume":"31","author":"X Liu","year":"2012","journal-title":"Stat Med"},{"issue":"9","key":"pntd.0014121.ref027","doi-asserted-by":"crossref","first-page":"1045","DOI":"10.1016\/0041-0101(94)90388-3","article-title":"Reliability of the simple 20 minute whole blood clotting test (WBCT20) as an indicator of low plasma fibrinogen concentration in patients envenomed by Bothrops snakes. Butantan Institute Antivenom Study Group","volume":"32","author":"IS Sano-Martins","year":"1994","journal-title":"Toxicon"},{"issue":"5","key":"pntd.0014121.ref028","doi-asserted-by":"crossref","DOI":"10.1016\/j.heliyon.2023.e15476","article-title":"Venom-gland transcriptomics of the Malayan pit viper (Calloselasma rhodostoma) for identification, classification, and characterization of venom proteins","volume":"9","author":"P Adisakwattana","year":"2023","journal-title":"Heliyon"},{"key":"pntd.0014121.ref029","doi-asserted-by":"crossref","first-page":"1259","DOI":"10.2147\/JMDH.S311556","article-title":"Coagulopathy after viper snakebite in Vietnam and relationship with time of admission","volume":"14","author":"XT Dang","year":"2021","journal-title":"J Multidiscip Healthc"},{"issue":"10","key":"pntd.0014121.ref030","doi-asserted-by":"crossref","first-page":"694","DOI":"10.3390\/toxins14100694","article-title":"Early adverse reactions to snake antivenom: Poison center data analysis","volume":"14","author":"C Sriapha","year":"2022","journal-title":"Toxins (Basel)"},{"issue":"1","key":"pntd.0014121.ref031","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1186\/s40560-016-0199-3","article-title":"Dynamics of fibrinogen in acute phases of trauma","volume":"5","author":"M Hayakawa","year":"2017","journal-title":"J Intensive Care"},{"issue":"2","key":"pntd.0014121.ref032","doi-asserted-by":"crossref","first-page":"241","DOI":"10.1097\/ALN.0000000000000463","article-title":"Practice guidelines for perioperative blood management: an updated report by the American Society of Anesthesiologists Task Force on Perioperative Blood Management*","volume":"122","author":"American Society of Anesthesiologists Task Force on Perioperative Blood Management","year":"2015","journal-title":"Anesthesiology"},{"issue":"4","key":"pntd.0014121.ref033","doi-asserted-by":"crossref","first-page":"615","DOI":"10.1111\/j.1538-7836.2012.04653.x","article-title":"Coagulation factor activity and clinical bleeding severity in rare bleeding disorders: results from the European Network of Rare Bleeding Disorders","volume":"10","author":"F Peyvandi","year":"2012","journal-title":"J Thromb Haemost"},{"issue":"5","key":"pntd.0014121.ref034","doi-asserted-by":"crossref","first-page":"593","DOI":"10.1111\/j.1365-2516.2004.00944.x","article-title":"The rare coagulation disorders--review with guidelines for management from the United Kingdom Haemophilia Centre Doctors\u2019 Organisation","volume":"10","author":"PHB Bolton-Maggs","year":"2004","journal-title":"Haemophilia"},{"issue":"8","key":"pntd.0014121.ref035","doi-asserted-by":"crossref","first-page":"801","DOI":"10.1182\/blood.2024025712","article-title":"How I treat quantitative fibrinogen disorders","volume":"145","author":"A Casini","year":"2025","journal-title":"Blood"},{"issue":"8","key":"pntd.0014121.ref036","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pntd.0009657","article-title":"The 20-minute whole blood clotting test (20WBCT) for snakebite coagulopathy-A systematic review and meta-analysis of diagnostic test accuracy","volume":"15","author":"T Lamb","year":"2021","journal-title":"PLoS Negl Trop Dis"},{"issue":"1","key":"pntd.0014121.ref037","doi-asserted-by":"crossref","first-page":"22","DOI":"10.4269\/ajtmh.1998.58.22","article-title":"Prognostic factors of green pit viper bites","volume":"58","author":"P Rojnuckarin","year":"1998","journal-title":"Am J Trop Med Hyg"}],"updated-by":[{"DOI":"10.1371\/journal.pntd.0014121","type":"new_version","label":"New version","source":"publisher","updated":{"date-parts":[[2026,3,20]],"date-time":"2026-03-20T00:00:00Z","timestamp":1773964800000}}],"container-title":["PLOS Neglected Tropical Diseases"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pntd.0014121","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,3,20]],"date-time":"2026-03-20T17:58:49Z","timestamp":1774029529000},"score":1,"resource":{"primary":{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pntd.0014121"}},"subtitle":[],"editor":[{"given":"Stuart Robert","family":"Ainsworth","sequence":"first","affiliation":[],"role":[{"role":"editor","vocabulary":"crossref"}]}],"short-title":[],"issued":{"date-parts":[[2026,3,16]]},"references-count":37,"journal-issue":{"issue":"3","published-online":{"date-parts":[[2026,3,16]]}},"URL":"https:\/\/doi.org\/10.1371\/journal.pntd.0014121","relation":{},"ISSN":["1935-2735"],"issn-type":[{"value":"1935-2735","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,3,16]]}}}