Impact of early fresh frozen plasma administration on clinical outcomes in snakebite-induced coagulopathy: A systematic review.

Envenoming continues to pose a substantial public health burden, particularly in tropical and subtropical low-resource settings. One of the most serious complications being venom-induced consumption coagulopathy (VICC), a condition where blood loses its ability to clot properly. Antivenom is the primary treatment, but reversal of coagulopathy is often delayed. Fresh frozen plasma (FFP) has been suggested is an additional therapy to replace depleted clotting factors and help blood clot faster. However, it is still unclear how effective FFP really is in improving recovery. To evaluate the effectiveness of early FFP administration, in addition to antivenom, in reducing morbidity and mortality among patients with snakebite-induced coagulopathy. A systematic review was carried out in accordance with PRISMA guidelines. A comprehensive search was performed in databases including PubMed, EMBASE, CINAHL, Cochrane, PsycINFO, and Google Scholar for studies published up to June 2025. Eligible studies included randomized controlled trials (RCTs) and clinical trials involving human patients with confirmed snakebite-induced coagulopathy, comparing the early FFP administration with standard treatment which is antivenom alone. Primary outcomes were mortality and morbidity (major bleeding, transfusion needs, surgical interventions, hospital stay). Secondary outcomes included improvement in laboratory clotting parameters and any treatment-related adverse events. Out of 138 records initially screened, five studies met the inclusion criteria, including two randomized controlled trials and three clinical trials, conducted in Australia, Sri Lanka, and India. Death rate was uniformly low across studies, and adding FFP did not show a statistically significant reduction in mortality. Across studies, FFP consistently shortened laboratory recovery of coagulation parameters (prothrombin time, INR, fibrinogen), reducing recovery time from ∼24 h to 6-12 h in some trials. However, its effect on clinical outcomes such as major bleeding events, surgical procedures, and length of hospital stay was variable and not consistently demonstrated. Two studies suggested reduced antivenom requirements with adjunctive FFP, though this was not reproduced in RCTs. Adverse effects were infrequent but included allergic reactions and one report of transfusion-related acute lung injury (TRALI). Early administration of FFP improves laboratory recovery of coagulopathy but shows no consistent benefit in reducing mortality or major morbidity in snakebite patients. While it may have a role in selected severe cases or resource-limited settings, routine use is not supported by current evidence. Larger multicenter trials with standardized outcome reporting are warranted to define its role in clinical practice.