Effects of reduced edoxaban administration on bleeding risk and D-dimer levels in patients wearing elastic stockings after total hip arthroplasty: A retrospective cohort study

Objective: Edoxaban is some-times given at reduced doses when used concomitantly with physical prophylaxis to prevent symptomatic venous thrombo-embolism (VTE) after total hip arthroplasty (THA). This study aimed to evaluate the safety of reduced doses of edoxaban admin-istered independent of the dose-reduction criteria and their effects on D-dimer levels after THA in Japanese patients. Materi-als and methods: This study enrolled 22 patients who received edoxaban 30 mg/ day and 45 patients who received edoxa-ban 15 mg/day with dose adjustment as a standard-dose group, and 110 patients who received edoxaban 15 mg/day without dose adjustment as a low-dose group. The incidence of bleeding events was then com-pared between groups with patients wear-ing elastic stockings. Multivariate regression analysis was also performed to examine the effect of edoxaban administration on D-di-mer levels after THA. Results: The incidence of bleeding events after THA did not differ significantly between groups. In the multi-variate model, dose reduction of edoxaban did not correlate with D-dimer levels on postoperative days 7 and 14, but higher D-dimer levels at postoperative days 7 and 14 correlated significantly with longer duration of surgery (odds ratio (OR) 1.66, 95% confi-dence interval (CI) 1.20 - 2.29, p = 0.002; OR 1.63, 95% CI 1.17 - 2.29, p = 0.004, respec-tively). Conclusion: These results suggest that information on the duration of surgery may be useful in the pharmaceutical man-agement in edoxaban drug prophylaxis com-bined with physical prophylaxis after THA in Japanese patients.