Intrathoracic hemocoagulase Bothrops atrox injection efficacy in thoracoscopic lung cancer surgery

Hemocoagulase Bothrops atrox (HBA) has been widely used to reduce perioperative bleeding in surgical procedures, while little is known about its specific efficacy and safety in video-assisted thoracoscopic surgery (VATS). This study aimed to evaluate the impact of intrathoracic HBA injection on perioperative outcomes and coagulation in patients undergoing VATS. We retrospectively included 388 patients who had lung cancer and received VATS. They were categorized into HBA (n = 51) and non-HBA (n = 337) groups. After 1:2 propensity score matching, 120 patients (45 HBA and 75 non-HBA) were included in final analysis. Multivariate analysis was performed to identify independent factors influencing postoperative thrombin time (TT). Before propensity score matching, the HBA group had significantly lower intraoperative bleeding volume, surgery duration, postoperative hospital stay, drainage volume, and drainage time compared to the non-HBA group (P < .001). Additionally, the HBA group had higher rates of comorbidities, more postoperative complications, and worse pre- and postoperative coagulation functions evaluated by international standardized ratio, activated partial thrombin time, prothrombin time, and fibrinogen level. After matching, the HBA group still demonstrated a higher TT (P = .006), shorter postoperative hospital stays (P = .001), and a lower drainage volume (P = .003) compared to non-HBA group. Multivariate analysis revealed that HBA (P = .009) and preoperative TT (P < .001) were independent risk factors for prolonged postoperative TT. Our study revealed that intrathoracic HBA injection in VATS may reduce postoperative hospital stay and drainage volume, albeit with prolonged TT. Monitoring coagulation function before and after surgery is necessary for patients receiving HBA during surgery.