Intrapleural hemocoagulase Bothrops atrox and early outcomes after VATS for stage IA non-small cell lung cancer

Hemocoagulase Bothrops atrox (HBA) is used to reduce surgical bleeding, but its impact on postoperative coagulation after video-assisted thoracoscopic surgery (VATS) remains unclear. We evaluated the effects of intrapleural HBA on coagulation profiles and early recovery in stage IA non-small cell lung cancer (NSCLC).

We retrospectively analyzed 442 stage IA NSCLC patients undergoing VATS, allocated to HBA (n = 92) or non-HBA (n = 350) groups. The primary outcome was postoperative coagulation; secondary outcomes were length of stay and postoperative complications. Baseline characteristics were balanced using inverse probability of treatment weighting (IPTW), followed by multivariable analyses.

After IPTW adjustment, intrapleural HBA was associated with a longer prothrombin time (PT; 12.83 ± 0.99 vs. 12.31 ± 1.50 s; β = 0.28, 95% CI 0.11-0.45, p = 0.001) and lower fibrinogen (FIB) levels (322.06 ± 96.68 vs. 353.52 ± 122.65 mg/dL; β = -33.33, 95% CI - 48.46 to -18.20, p < 0.001), while activated partial thromboplastin time and thrombin time did not differ significantly. In the IPTW-weighted cohort, HBA use was associated with a lower incidence of postoperative complications (6.5% vs. 12.0%; OR = 0.35, 95% CI 0.19-0.63, p = 0.001) and a shorter postoperative hospital stay (β = -2.06, 95% CI - 2.61 to -1.50, p < 0.001).

Intrapleural HBA injection in stage IA NSCLC undergoing VATS is associated with modest alterations in coagulation (prolonged PT and reduced FIB) and improved early outcomes, including fewer complications and shorter hospitalization. Prospective studies are warranted to confirm these findings.