Comparison of Bleeding Profiles of Sugammadex and Neostigmine in
Orthotopic Liver Transplantation
Abstract
In the era of “fast-track’ liver transplantation (LT), neuromuscular
blockade (NMB) antagonists such as neostigmine or sugammadex are used to
achieve the restoration of neuromuscular function. While sugammadex
reverses NMB faster than neostigmine, it has been shown to prolong
prothrombin time (PT) and activated thromboplastin time (aPTT). However,
this agent’s impact on coagulation during LT is not understood. We
compare bleeding risk associated with sugammadex versus neostigmine
during liver transplantation. This is a single-center, retrospective
review of LT patients who received NMB antagonists intraoperatively
between 01/01/2015 to 05/31/2018 at Mayo Clinic in Florida. The primary
outcomes were postoperative day (POD) 0-1 bleeding events and POD 0
values of aPTT and INR. Total 241 patients were included, with 135
patients in the neostigmine group (NG) and 106 in the sugammadex group
(SG). POD 0-1 postoperative bleeding requiring transfusion occurred in
20% of NG versus 10.4% in SG. POD 0-1 re-operation for bleeding
occurred in 1.5% in NG vs. 0% in SG. POD 0 mean INR was 2.0±0.4 in
both groups. POD 0 mean aPTT was 45.5±7.9 in NG vs. 49.3±9.0 in SG. Our
retrospective study suggests that sugammadex is not associated with an
increased risk of bleeding compared to neostigmine use.