Posted by Purpose: Although sugammadex may promote earlier postoperative mobilization and transiently affect coagulation parameters, its association with the risk of venous thromboembolism (VTE) following total knee arthroplasty (TKA) remains uncertain.
Patients and Methods: This multi-institutional retrospective cohort study used the TriNetX research network to identify patients aged ≥45 years who received rocuronium and underwent primary TKA between 2010 and 2024. Patients were stratified according to the neuromuscular blockade reversal agent received: sugammadex or neostigmine, with neostigmine serving as the active comparator. Following 1:1 propensity score matching, 22,844 matched pairs were included in the analysis. The primary outcome was the incidence of VTE within 14 days after surgery. Secondary outcomes included deep vein thrombosis (DVT), pulmonary embolism (PE), pneumonia, urinary tract infection (UTI), postoperative nausea and vomiting (PONV), and mortality at 14 and 90 days.
Results: Sugammadex use was associated with a significantly lower risk of VTE at 14 days compared with neostigmine (odds ratio [OR], 0.60; 95% confidence interval [CI], 0.49–0.74; p < 0.001; absolute risk difference, −0.41 percentage points). The risks of both DVT (OR, 0.65; p = 0.001) and PE (OR, 0.58; p = 0.001) were also significantly lower with sugammadex. The association with reduced VTE risk persisted at 90 days (OR, 0.72; 95% CI, 0.62–0.84; p < 0.001; absolute risk difference, −0.50 percentage points). Sugammadex use was additionally associated with lower rates of pneumonia (p = 0.018), UTI (p < 0.001), and PONV (p = 0.005) at 14 days, with no significant difference in mortality. Sensitivity and subgroup analyses demonstrated findings consistent with the primary analysis.
Conclusion: In this retrospective cohort study, sugammadex use was associated with a significantly lower risk of VTE following primary TKA, including reductions in both DVT and PE. However, given the observational study design and the possibility of residual confounding, these hypothesis-generating findings should be interpreted cautiously and warrant confirmation in prospective randomized trials to clarify the underlying mechanisms and clinical significance of this association.
Lan KM, Kao CL, Chang YJ. Association of Sugammadex Exposure with Venous Thrombosis Risk Following Primary Total Knee Arthroplasty: A Multi-Institutional Retrospective Analysis. Drug Des Devel Ther. 2026;20:607942. https://doi.org/10.2147/DDDT.S607942