Author’s Reply

We thank the authors for reading our article with interest. The authors suggest that prothrombin Time (PT) and international normalized ratio (INR) values were not done in the patients. Particularly, INR values are important in diagnosing and monitoring thrombotic microangiopathy (TMA). In response, our study defined TMA as the triad of microangiopathic hemolytic anemia, thrombocytopenia, and acute kidney injury. Prothrombin time is normal in TMA.[1] Prolonged PT and INR in snakebite envenoming is because of VICC and not TMA. The role of INR values in diagnosing and monitoring TMA is not established.[2] In our study, the selection criteria for coagulopathy was a positive 20-minute whole blood clotting test (20 WBCT), which is a simple bedside test. The test is used globally, particularly in low-resource settings. We agree this is a less reliable test in comparison to the estimation of activated partial thromboplastin time (APTT), PT, and INR. However, a positive 20 WBCT test is considered at risk for developing TMA in a patient with snakebite.[2] We agree with the authors that the prevalence of VICC was not assessed in our study and investigations such as estimations of D-dimer, fibrinogen, PT, APTT, and INR levels were not carried out. A future study on the prevalence of TMA in patients with VICC (consumption coagulopathy) as well as with anticoagulant coagulopathy is necessary; where in diagnosis of VICC and anticoagulant coagulopathy is based on APTT, PT, INR, D-dimer, and fibrinogen levels. Data availability statement The data is available in the article. It will be shared upon reasonable request to the corresponding author. Author contribution Sujeet Raina is the corresponding author. Sujeet Raina has written the draft of author’s reply on behalf of all the authors. Financial support and sponsorship Nil. Conflicts of interest There are no conflicts of interest.