Severe recurrent coagulopathy following crotaline envenomation refractory to maintenance dosing of antivenom

Since the first published clinical trials on the use of CPIF, a phenomenon called recurrence has been recognized in some patients treated with this product that did not seem to be described with the same frequency in patients treated with the previous whole-IgG product [1-3]. Larger clinical experience will be needed to definitively judge the efficacy of the F(ab')2 product to prevent recurrence in North American crotaline bites. [...]widespread availability of the F(ab')2 product and its efficacy are established, clinicians must be diligent in following crotaline envenomations treated with CPIF in parts of the country where recurrence is prevalent to help prevent late bleeding complications.