Abstract
To the Editor:
We would like to thank Dr Mullins and Dr Ali for their comments 1 regarding our article “Rebound coagulopathy in patients with snakebite presenting with marked initial coagulopathy.” 2 I would like to point out that the intent of our article was to report a rare and potentially clinically significant finding in snake bite patients that to our knowledge had not been previously reported.
In regard to Dr Mullins and Dr Ali’s first question about the snake identification in the case of patient 2, I offer the following: As Dr Mullins and Dr Ali noted, we live in an area with both copperheads and rattlesnakes. Historically, we see 4 to 5 copperhead bites per 1 rattlesnake bite, although admittedly the number varies greatly by year. We do our best to identify the snake, and many of our patients are “snake fluent.” I stand by the described history, but I do not in any way deny that coagulopathy is much more common (and severe) with rattlesnake bites.
In regard to Dr Mullins and Dr Ali’s second question as to whether more crofab “could have prevented” the rebound coagulopathy, I have no data to support or deny that assertion. We take a symptomatic and laboratory-driven approach to crofab administration, as I believe most centers do. Although I cannot argue that more crofab might have prevented the rebound, I do not believe we had an indication to give the patient additional crofab.