Background: Snakebites comprise an important neglected public health problem that affects people worldwide. Hematologic abnormalities are the most common effects of snake envenoming specially the venom-induced consumption coagulopathy.
The novel coronavirus disease of 2019 (COVID‐19) is caused by the severe acute respiratory syndrome coronavirus 2 (SARS‐CoV2). Venous thromboembolism (VTE) has emerged as an important complication in the management of hospitalized patients with COVID. Manage both situations might be challenging.

Aims: Describe the successful treatment of our group in conduct a patient with both hemorragic (Snake venom) and thrombotic risk factors ( COVID19).

Methods: Case report of a patient with both hemorragic and thrombotic risk factors.

Results: Female patient, 33 years old, had a snake envenomation in a waterfall in Brazil. She received, in the hospital close to the accident site, specific anti-venon sérum, Where the diagnosis of SARS-CoV-2 infection was made even though the patient was asymptomatic.At entrance, the patient underwent fasciotomy due to compartment syndrome in the left upper limb. However, it evolves with hemorrhagic shock in the postoperative period. Based on complementary exams, that revealed disseminated intravascular coagulation with hyperfibrinolyses (figure 1).

Patient’s thromboelastography at entrance

She was treated with tranexamic acid, prothrombin complex, recombinant fibrinogen, vitamin K, parenteral iron, and prescribed compressive curative, red blood cell and platelet transfusion.After reversed the coagulopathy, 48 hours after initial measurements (table 1), it was evidenced an increase in D-dimer (above 7650ng/ml) and fibrin degradation products (above 120). As patient had many risk factors for venous thromboembolism (immobilization, recent surgery and SARS-CoV-2) and following institutional protocols, we started prophylactic anticoagulation. Patient was discharged with progressive improvement after one month of hospitalization with instruction to maintain oral anticoagulation in prophylactic dose for more 30 days.

Evolution of exams during treatment

Conclusions: The use of institutional protocols and appropriate coagulation tests can make the difference in patient manejament with hemorragic and/or thrombotic deseases.

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ISTH Congress Abstracts - https://abstracts.isth.org/abstract/management-of-a-patient-with-hemorragic-and-thrombotic-risk-factors-a-brazilian-case-report/