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Updated: Mar 24, 2026
In Vitro Thrombosis Test for Ventricular Assist Devices
Published on: March 21, 2025
Anticoagulant Effect of Sugammadex: Just an In Vitro Artifact
Daniel Dirkmann1, Martin W Britten, Henning Pauling
1From the Klinik für Anästhesiologie und Intensivmedizin (D.D., M.W.B., H.P., J.W., K.G., J.P.) and Abteilung für Klinische Chemie (L.V.), Universität Duisburg-Essen and Universitätsklinikum Essen, Essen, Germany.
Background:
Sugammadex prolongs activated partial thromboplastin time (aPTT) and prothrombin time (PT) suggestive of anticoagulant effects. To pinpoint its presumed anticoagulant site of action, the authors assessed Sugammadex's impact on a panel of coagulation assays.
Methods:
Sugammadex, Rocuronium, Sugammadex and Rocuronium combined, or saline were added to blood samples from healthy volunteers and analyzed using plasmatic (i.e., aPTT, thrombin time, and fibrinogen concentration) (n = 8 each), PT (quick), activities of plasmatic coagulation factors, and whole blood (extrinsically and intrinsically activated thromboelastometry) assays (n = 18 each). Furthermore, dose-dependent effects of Sugammadex were also assessed (n = 18 each) in diluted Russel viper venom time (DRVVT) assays with low (DRVVT1) and high (DRVVT2) phospholipid concentrations and in a highly phospholipid-sensitive aPTT assay.
Results:
Sugammadex increased PT (+9.1%; P < 0.0001), aPTT (+13.1%; P = 0.0002), and clotting time in extrinsically (+33.1%; P = 0.0021) and intrinsically (+22.4%; P < 0.0001) activated thromboelastometric assays. Furthermore, activities of factors VIII, IX, XI, and XII decreased (-7%, P = 0.009; -7.8%, P < 0.0001; -6.9%, P < 0.0001; and -4.3%, P = 0.011, respectively). Sugammadex dose-dependently prolonged both DRVVT1 and the highly phospholipid-sensitive aPTT assays, but additional phospholipids in the DRVVT2 assay almost abolished these prolongations. Thrombin time, a thromboelastometric thrombin generation assay, clot firmness, clot lysis, fibrinogen concentration, and activities of other coagulation factors were unaltered. Rocuronium, Sugammadex and Rocuronium combined, and saline exerted no effects.
Conclusion:
Sugammadex significantly affects various coagulation assays, but this is explainable by an apparent phospholipid-binding effect, suggesting that Sugammadex`s anticoagulant effects are likely an in vitro artifact.
Insights
Sugammadex prolongs coagulation tests, but this effect is likely an in vitro artifact due to phospholipid binding. Further research is needed to understand its clinical relevance.
Area of Science:
- Pharmacology
- Hematology
- Clinical Chemistry
Background:
- Sugammadex is known to prolong activated partial thromboplastin time (aPTT) and prothrombin time (PT).
- The precise mechanism and site of action for these observed anticoagulant effects remain unclear.
Purpose of the Study:
- To investigate the impact of Sugammadex on various coagulation assays.
- To determine the potential anticoagulant site of action for Sugammadex.
Main Methods:
- Coagulation assays were performed on blood samples from healthy volunteers.
- Assays included plasmatic tests (aPTT, PT, thrombin time, fibrinogen), coagulation factor activities, and whole blood thromboelastometry.
- Dose-dependent effects were assessed using diluted Russell's viper venom time (DRVVT) assays with varying phospholipid concentrations.
Main Results:
- Sugammadex significantly prolonged PT, aPTT, and thromboelastometry clotting times.
- Activities of coagulation factors VIII, IX, XI, and XII were decreased by Sugammadex.
- Dose-dependent prolongation in DRVVT and aPTT assays was mitigated by additional phospholipids, suggesting phospholipid binding.
Conclusions:
- Sugammadex exhibits significant effects on multiple coagulation assays.
- These effects are likely an in vitro artifact attributable to Sugammadex's phospholipid-binding properties.
- The clinical significance of these observed in vitro anticoagulant effects requires further investigation.
