Background:The monitoring of the effects of direct oral anticoagulants may be beneficial during emergencies and adverse events. We aimed to explore direct oral anticoagulant monitoring in “real-world” settings, in which monitoring methods are limited and loading time can be estimated based on only patient reports.Methods:In 164 patients, plasma anti-Xa activity was assessed using a STA®-Liquid Anti-Xa reagent (Diagnostica Stago, Asnieres, France), and prothrombin time was measured using HemosIL® RecombiPlasTin 2G (Instrumentation Laboratory, Bedford, MA, USA). The loading time was calculated according to the previous dosing time reported by the patient. In the clinic setting, rivaroxaban and apixaban were administered to 103 patients with atrial fibrillation and a blood sample was tested once during a clinic visit. In the hospitalization setting, edoxaban was administered to 61 patients undergoing arthroplasty for prophylaxis of a venous thrombosis and blood samples were tested 3 and 18 h after the last intake.Results:Plasma Xa activity in the clinical setting ranged widely (rivaroxaban: 1.1–424.4 ng/mL, apixaban: 15.4–469.2 ng/mL) during the 11.7 ± 7.0 h following the previous dose. The values varied over a wide range (up to a factor of 2) at the same loading time, especially around the peak period. The plasma anti-Xa activity of rivaroxaban and apixaban showed linear correlations with prothrombin time (R2 = 0.828 and 0.717, respectively). Edoxaban administration prolonged the prothrombin time by only 1.6 ± 1.1 s from the trough to the peak, to a degree that was negatively correlated with age, but not with plasma creatinine level, creatinine clearance, or body mass index.Conclusion:In real-world settings, plasma anti-Xa monitoring should be interpreted considering the wide variations in data, reflecting the variability in patient-reported loading time and interpatient variability.

Background: EF-14 trial showed the efficacy of tumor treating fields (TTF), and TTF was approved as a standard therapy for glioblastoma. In TTF opening, Device Support Specialist (DSS) should explain how to use it for the patient and family. However no DSS does always stay in our Yamaguchi prefecture, and DSS has to come to our hospital across other prefectures. On the other hand, COVID-19 infection is still spreading and it is sometimes tough to move from a big city to countryside. Here, we would present the first experience of TTF opening with online DSS support. A case report: A 68 years old man had right hemiparesis. MRI showed multiple lesions in the left hemisphere, and biopsy showed glioblastoma. After 1 month from chemo and radiotherapy, TTF was introduced. DSS from Tokyo explained how to use TTF via PC camera with TV monitor. A skilled neurosurgeon and special nurse also helped them in front of him. His head and the attached array were well checked from DSS with PC camera moving around him. Everything was smooth and he started TTF. Conclusion: Online medicine should be absolutely spreading. In countryside, it is hard that DSS comes to our hospital from a big city. TTF opening could be favorable via online system with skilled medical stuffs.

Background: EF-14 trial showed the efficacy of tumor treating fields (TTF), and TTF was approved as a standard therapy for glioblastoma in Japan. In TTF opening, Device Support Specialist (DSS) explains how to use it for the patient and the family. Because there is no DSS in Yamaguchi prefecture, DSS has to come to our hospital across other prefectures. On the other hand, COVID-19 is still spreading and it is sometimes tough to move from a big city to countryside. Here, we would present the experiences of TTF opening with online DSS support. Method: From June 2020, Zoom was used for 4 patients, and from June 2021, iPad/Face-Time was used for one patient. TTF was introduced via online DSS support with direct support from our nurse in our out clinic. After that, initial times of TTF change were performed via online DSS support in patient’s home. Two patients who used Zoom had trouble to connect to internet, however finally completed with relative helps.Conclusion: Online medicine should be absolutely spreading in country sides. Now, we change from Zoom to iPad, because the old patients in country sides were hard to use internet utility. We should make efforts to provide patients more brief methods of online support.