The Effect of Sugammadex on Prothrombin and Activated Partial Thromboplastin Time

Samara, Evangelia; Stamatiou, Konstantinos; Balanika, Marina; Τζίμας, Πέτρος

doi:10.7759/cureus.14521

Cited by 5 publications

(9 citation statements)

References 22 publications

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“…3 The selective relaxant binding agent sugammadex has demonstrated to effectively and quickly restore neuromuscular function from a neuromuscular blockade by rocuronium or vecuronium. 4 However, it may increase a risk of postoperative bleeding due to its anticoagulatory effect 5 or a risk of hypersensitivity reactions and anaphylaxis. 6 Although anaphylaxis and coagulation abnormalities with sugammadex are indeed a problem, they are infrequent and sugammadex can be used safely in most cases.…”

Section: Introductionmentioning

confidence: 99%

Adamgammadex in patients to reverse a moderate rocuronium‐induced neuromuscular block

Ying

Zhang

Zhu

et al. 2022

Brit J Clinical Pharma

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The aim of this study was to investigate the effectiveness, safety and pharmacokinetics of adamgammadex in surgical patients.Methods: Forty-eight patients aged 18-64 years old were randomized to receive adamgammadex (2, 4, 6, and 8 mg.kg À1 ) or placebo at a ratio of 10:2 for reversal of 0.6 mg.kg À1 rocuronium-induced neuromuscular block. Neuromuscular function was monitored by TOF-Watch ® SX. When the T 2 of train-of-four (TOF) reappeared at the end of surgery, patients received an intravenous administration of adamgammadex or placebo. Results:The recovery time of the TOF ratio to 0.9 decreased significantly from 39.3 [29.5, 50.2] minutes in the group that received placebo to 3.0 [2.3, 3.9] minutes, P < .0001; 2.1 [1.5, 3.0] minutes, P < .0001; 2.1 [1.8, 3.3] minutes, P < .0001; and 1.8 [1.5, 2.2] minutes, P < .0001 in the 2, 4, 6 and 8 mg.kg À1 adamgammadex groups, respectively. Then, adamgammadex also showed a shortened recovery time for the TOF ratio recovered to 0.8 and 0.7. Adamgammadex was well tolerated, and no cases of anaphylactic reactions, post-operative bleeding, recurarization, abnormal basic vital signs and prolonged QT intervals were observed. The pharmacokinetics of adamgammadex in plasma increased in dose-dependent manner. The 24-hour cumulative fraction of adamgammadex in urine was 65-83%, and that of rocuronium was increased after using adamgammadex from 15% to about 25-30%. Conclusion:Adamgammadex was found to be effective for reversal of rocuroniuminduced neuromuscular block, and it was safe and well tolerated in patients.YingYing Jiang and YuJun Zhang contributed equally to this work.The authors confirm that the Principal Investigators for this paper are WenSheng Zhang and Bin Liu, and that they had direct clinical responsibility for patients.

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Section: Introductionmentioning

confidence: 99%

Adamgammadex in patients to reverse a moderate rocuronium‐induced neuromuscular block

Ying

Zhang

Zhu

et al. 2022

Brit J Clinical Pharma

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“…12,13,15,20 The increase seems to be dose-dependent and temporary, resolving after around 1 hour. 19 Consequently, no difference in RBC transfusion nor laboratory parameters has been demonstrated in surgical patients having a liver transplantation after 24 hours of sugammadex administration. 21 It has been further postulated that the prolongation in coagulation assays associated with sugammadex could be secondary to an in vitro artifact by an apparent phospholipid-binding effect.…”

Section: Discussionmentioning

confidence: 99%

“…18 The initial concern that sugammadex may interfere with coagulation is based on early studies on coagulation laboratory parameters. 19 Multiple studies reported a prolongation of several coagulation parameters, especially aPTT and INR, after sugammadex application. 12,13,15,20 The increase seems to be dose-dependent and temporary, resolving after around 1 hour.…”

Section: Discussionmentioning

confidence: 99%

Postoperative Risk of Transfusion After Reversal of Residual Neuromuscular Block With Sugammadex Versus Neostigmine: A Retrospective Cohort Study

Schmidt

Paredes

Rössler

et al. 2023

Anesthesia &Amp; Analgesia

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BACKGROUND: Sugammadex and neostigmine are routinely used to reverse residual neuromuscular blocks at the end of surgery. Sugammadex has been linked with prolongation of laboratory coagulation markers, but clinical relevance on postoperative blood loss and transfusions remains unclear. METHODS: In this retrospective, single-center, cohort study, we analyzed medical records of adult patients having noncardiac surgery who were given sugammadex or neostigmine from May 2016 to December 2020. Our primary outcome was the incidence of any postoperative transfusion of red blood cells, and/or fresh-frozen plasma, and/or platelets. Secondary outcomes were duration of hospitalization, need for resurgery, and postoperative intensive care unit (ICU) admission. After propensity score weighting, the odds ratio (OR) for postoperative transfusion was assessed in both groups (sugammadex versus neostigmine) using a generalized estimation equation to count within-subject correlation weighted by the inverse propensity score. RESULTS: Out of 39,325 eligible surgeries, 33,903 surgeries in 29,062 patients were included in the analysis; with 4581 patients receiving sugammadex and 29,322 patients receiving neostigmine. The raw incidence of postoperative transfusion was 7.40% in sugammadex and 7.45% in the neostigmine group. After weighting by propensity score, the incidence of postoperative transfusion was 8.01% in the sugammadex and 7.38% in the neostigmine group (OR, 1.11 [95% confidence interval [CI], 0.97-1.26; P = .118]). There was no difference in duration of hospitalization and need for resurgery, but odds of postoperative ICU admission were significantly higher for patients receiving sugammadex than those receiving neostigmine (OR, 1.33 [98.33% CI, 1.17-1.52; P < .0001]). Our a priori planned analysis of coagulation laboratory parameters could not be completed because of a high amount of missing laboratory data. CONCLUSIONS: There is no statistically significant nor clinically important difference in the risk of postoperative transfusion in patients receiving sugammadex or neostigmine. (Anesth Analg 2023;136:745-52) KEY POINTSSummary statistics (presented as % of patients, mean ± SD, or median [Q1-Q3], respectively, for factors, symmetric continuous variables, and skewed continuous variables; Duration of surgery was summarized by median [10th, 90th percentiles]). Abbreviations: ASA, American Society of Anesthesiologists; ASD, absolute standardized difference; BMI, body mass index; IPTW, inverse probability of treatment weighting. a ASD is the absolute difference in means or proportions divided by the pooled standard deviation before or after weighting each observation with IPTW. Any covariate with an ASD >0.10 was considered to be imbalanced and would be adjusted for in the analysis.

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“…16,17 Additionally, sugammadex has been reported to cause QT prolongation, bradycardia, cardiac arrest, increased prothrombin time, and increased activated partial thromboplastin time. [17][18][19] Finally, recurrence of neuromuscular blockade can occur with lower sugammadex doses despite initial reversal. 17,19 These effects should be considered by providers when weighing the risks and benefits of neuromuscular blockade reversal.…”

Section: Discussionmentioning

confidence: 99%

Sugammadex Efficacy and Dosing for Rocuronium Reversal Outside of Perioperative Settings

et al. 2022

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Background: Sugammadex is approved for postoperative recovery from rocuronium neuromuscular blockade with train-of-four (TOF) guided dosing. Data for non-perioperative sugammadex efficacy and dosing are limited when TOF is not available and reversal is not immediate. Objective: This study evaluated the efficacy, safety, and dose of sugammadex when administered in the emergency department (ED) or intensive care unit (ICU) for delayed rocuronium reversal when TOF guidance was not consistently available. Methods: This single-center, retrospective cohort study included patients over a 6-year period who received sugammadex in the ED or ICU at least 30 minutes after rocuronium administration for rapid sequence intubation (RSI). Patients who received sugammadex for intra-operative neuromuscular blockade reversal were excluded. Efficacy was defined as successful reversal documented in progress notes, TOF assessment, or improvement in Glasgow Coma Scale (GCS). Dose was evaluated in patients with successful reversal by correlating sugammadex and rocuronium dose with reversal time after paralysis. Results: Thirty-four patients were included with 19 (55.9%) patients receiving sugammadex in the ED. Sugammadex indication was acute neurologic assessment in 31 (91.1%) patients. Twenty-nine patients (85.2%) had successful reversal documented. The remaining 5 patients had fatal neurologic injuries with GCS 3 limiting non-TOF efficacy assessment. The median (IQR) sugammadex dose was 3.4 (2.5-4.1) mg/kg administered 89 (56.3-158) minutes after rocuronium. No correlation was identified between sugammadex dose, rocuronium dose, and administration time. No adverse events were noted. Conclusion: This pilot investigation demonstrated safe and effective rocuronium reversal with sugammadex 3 to 4 mg/kg administered in the non-operative setting 1 to 2 hours after RSI. Larger, prospective studies are necessary to determine the safety in patients outside of the operating room when TOF is not available.

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The Effect of Sugammadex on Prothrombin and Activated Partial Thromboplastin Time

Cited by 5 publications

References 22 publications

Adamgammadex in patients to reverse a moderate rocuronium‐induced neuromuscular block

Adamgammadex in patients to reverse a moderate rocuronium‐induced neuromuscular block

Postoperative Risk of Transfusion After Reversal of Residual Neuromuscular Block With Sugammadex Versus Neostigmine: A Retrospective Cohort Study

Sugammadex Efficacy and Dosing for Rocuronium Reversal Outside of Perioperative Settings

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