Management of patients after total knee arthroplasty using mechanical prophylaxis and reduced doses of edoxaban: A retrospective cohort study.

OBJECTIVE: Edoxaban is given as pharmacologic prophylaxis alone or in combination with mechanical prophylaxis for venous thromboembolism after total knee arthroplasty. Several choices are made regarding edoxaban dosages when used in combination with mechanical prophylaxis. This study aimed to compare efficacy and safety in patients who received edoxaban with elastic stockings after total knee arthroplasty between those who received the standard dose, including those who received a reduced dose after meeting dose reduction criteria, and those who received reduced doses without dose reduction criteria. MATERIALS AND METHODS: This study included 143 patients in the standard-dose group (with 125 patients receiving dose-adjusted edoxaban 15 mg/day) and 110 patients in the low-dose group, and it compared the incidence of venous thromboembolism and bleeding events between groups. The impact of edoxaban administration on the occurrence of venous thromboembolism after total knee arthroplasty was also examined using multivariate regression analysis. RESULTS: Our results showed that rates of venous thromboembolism and bleeding events in patients wearing elastic stockings after total knee arthroplasty were similar in both standard- and low-dose groups. Multivariate regression analysis showed that use of reduced-dose edoxaban without dose adjustment did not correlate with the occurrence of venous thromboembolism, but edoxaban administration was significantly associated with older age and longer surgery time (odds ratio 1.84, 95% confidence interval 1.04 - 3.25, p = 0.036; odds ratio 1.69; 95% confidence interval 1.09 - 2.62, p = 0.019). CONCLUSION: These results suggest that reduced dose selection of edoxaban for patients who receive mechanical prophylaxis after total knee arthroplasty and post-administration pharmacological management may be useful.

Increased Arbekacin Clearance in Patients With Febrile Neutropenia.

BACKGROUND: Arbekacin (ABK) is used to treat infections caused by methicillin-resistant Staphylococcus aureus and is used widely for the treatment of febrile neutropenia (FN). As ABK has a narrow therapeutic concentration window, the dosage must be adjusted via therapeutic drug monitoring. However, the influence of the physiology of patients with FN on the pharmacokinetic (PK) parameters of ABK remains unclear. Therefore, we examined this influence on ABK PK parameters. METHOD: We performed a retrospective cohort study using data from patients with a hematologic malignancy who were ≥18 years and had been administered ABK. We excluded patients who did not receive therapeutic drug monitoring and had an estimated glomerular filtration rate (eGFR) of <30 mL/min, because clinically sufficient data would not be available. RESULT: Of the 99 enrolled patients, 25 did not have FN and 74 had FN. Arbekacin clearance (CLabk) was shown to correlate with eGFR in patients with FN (r = 0.32, P = 0.0062) and without FN (r = 0.50, P = 0.01). CLabk was higher in patients with FN than in those without FN. In addition, in the eGFR of <100 mL/min group (normal renal function), CLabk and CLabk/eGFR were also higher in patients with FN than in those without FN. CONCLUSIONS: CLabk was increased in patients with FN and normal renal function; therefore, we propose an increased ABK dose for patients with FN and normal renal function.

Viral diseases of fish in Japan.

Viruses causing infectious pancreatic necrosis (IPN) and infectious hematopoietic necrosis (IHN) were first isolated in Japan during the 1970s and these two diseases remain among the most serious problems affecting cultured salmonids in Japan. In addition to IHN and IPN, four other viral diseases cause major economic losses among cultured fishes in Japan. These include viral pancreatic hepatic necrosis of yellowtail, rhabdovirus infection of Japanese flounder and black rock fish, Kuchishiro-sho of tiger puffer fish, and epidermal hyperplasia or necrosis of Japanese flounder. Over the years, a number of other viruses have been isolated from, or have been observed by electron microscopy, in moribund fish. Members of 10 of the existing families of animal viruses are represented in this group. Their importance to the aquaculture industry in Japan is reviewed here.