Background <p>Sugammadex, an innovative agent that rapidly and completely reverses rocuronium-induced neuromuscular blockade, may prolong coagulation time and influence postoperative bleeding. This study aimed to investigate the effects of sugammadex on coagulation parameters.</p> Methods <p>Cochrane Central Register of Controlled Trials, Embase, and PubMed were searched on September 25, 2024, for randomized control trials (RCTs) examining the impact of sugammadex on coagulation time.</p> Results <p>Five RCTs involving 1328 participants were included. Four RCTs with 1302 participants provided data for the meta-analysis. Sugammadex was found to prolong prothrombin time (PT) without affecting activated partial thromboplastin time (APTT).</p> Conclusions <p>Sugammadex administration may transiently increase PT values without affecting the APTT. Routine coagulation monitoring is not required in healthy individuals; however, individualized assessment should be conducted in high-risk patients. Further studies are warranted to evaluate the coagulation effects of sugammadex in patients with coagulopathies or those receiving anticoagulant therapy.</p> Trial registration <p>This study is registered in the PROSPERO database under the ID CRD42024604567.</p>