Does fasting during Ramadan influence the therapeutic effect of warfarin?

Sridharan, Kannan; Banna, Rashed Al; Qader, Ali Mohamed; Husain, Aysha

doi:10.1111/jcpt.13254

Cited by 8 publications

(5 citation statements)

References 13 publications

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“…They attributed these findings to dietary factors, changes in sleep patterns, and shifts in meal & medication timing. However, their study had limitations, including a small sample of 32 patients in the Far East, predominantly using warfarin for nonvalve-related conditions, with the majority having venous thromboembolism (84.3%) or atrial fibrillation (9.4%), and only 6.3% with mechanical valve replacements (2) Two studies, including one conducted in 2020; Sridharan., et (10), and a prospective study in Egypt; Rifaie et al, (11)-found no significant changes in mean INR values during, before, or after Ramadan, contrary to prior research. There was a retrospective study included 183 patients in Bahrain and didn't identify any significant differences in mean INR across pre-Ramadan, Ramadan, and post-Ramadan periods, with a limitation being its retrospective design.…”

Section: Discussionmentioning

confidence: 81%

“…This amplified fluctuation on both sides of the therapeutic range likely explains the insignificant difference in overall mean INR before and during Ramadan as observed in study of Alghamdi., et al (12). Contradictory findings were reported by Sridharan., et al (10), where fewer patients reached the therapeutic range during Ramadan, and more were within the subtherapeutic range, with a significantly higher proportion in the supra-therapeutic range post-Ramadan.…”

Section: Discussionmentioning

confidence: 93%

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Effect of Ramadan Fasting on the International Normalized Ratio and Prosthetic valve function in Patients with Mechanical Prosthetic Heart Valves

Abdelrahman,

Ammar,

El-morshedy

et al. 2023

Benha Medical Journal

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Background: Ramadan fasting presents unique challenges for patients with mechanical prosthetic heart valves on Warfarin therapy. This study aimed to evaluate the potential effects of Ramadan fasting and lifestyle changes during Ramadan on the International Normalized Ratio (INR) level in patients using Vitamin K anticoagulant VKA (Warfarin) for mechanical prosthetic heart valves as anticoagulation. Methods: This prospective study included 150 Muslim patients with mechanical prosthetic heart valves, tracking their INR levels over a period encompassing the month of Ramadan. Patients underwent regular assessments, including clinical examinations, INR measurements, and echocardiography. Data were collected on medication regimens, Warfarin intake timing, and fasting adherence. Results: The mean INR levels increased during Ramadan, with the most significant rise occurring in the last two weeks. Patients exhibited a significantly higher mean INR during Ramadan compared to the pre-Ramadan and post-Ramadan periods. Importantly, more patients reached the supra-therapeutic INR range during Ramadan, while fewer were within the sub-therapeutic range when compared to the post-Ramadan phase. Conclusion: Ramadan fasting can lead to significant fluctuations in INR levels in patients with mechanical prosthetic heart valves using Warfarin. Careful monitoring and adjustment of anticoagulation therapy may be necessary to maintain therapeutic INR ranges during this religious observance.

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Section: Discussionmentioning

confidence: 81%

Section: Discussionmentioning

confidence: 93%

Effect of Ramadan Fasting on the International Normalized Ratio and Prosthetic valve function in Patients with Mechanical Prosthetic Heart Valves

Abdelrahman,

Ammar,

El-morshedy

et al. 2023

Benha Medical Journal

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“…The alterations in the anticoagulation response to warfarin and the associated risk factors were examined. 51 One-hundred eighty-three patients receiving warfarin for at least 1 year were included in the study. Warfarin sensitivity index (WSI), prothrombin time international normalized ratio (PT-INR) category, and time spent in therapeutic range (TTR) were assessed.…”

Section: Impact Of Rf On Rheumatology Hematology and Oncology Practicesmentioning

confidence: 99%

Ramadan Fasting in Health and Disease in 2021: A Narrative Review

Hassan-Beck

Hafidh

Badi³

et al. 2022

Ibnosina Journal of Medicine and Biomedical Sciences

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Introduction: The literature on the health aspects of Ramadan fasting (RF) is widely spread in many journals. Materials and Methods: This is a narrative review of data obtained from the PubMed database (National Library of Medicine, Bethesda, Maryland, United States). We used the search term “Ramadan fasting,” and relevant records were examined. The publications are narrated thematically. Results: The publications spanned fundamental, clinical, professional, cultural, and advocacy facets. The publications crossed conventional disciplinary lines and geographical locations and appeared in journals with different access systems. The contents are presented under the themes that emerged depending on the retrieved literature. This year basic coverage included changes in physiology and nutrition during Ramadan. However, the clinical issues included a wide range of topics. These included the impact of RF on nonalcoholic fatty liver disease and adjustments needed in endocrine replacement therapy for hypothyroidism and adrenal insufficiency. Coverage also included chronic kidney disease. The impact on maternal health, fetal well-being, and long-term effects of RF exposures were addressed in several studies. Studies in cardiovascular medicine focused on blood pressure and cardiovascular risk factors. Sports medicine and athletes' well-being received somewhat prominent coverage. The impact on renal function, particularly in patients with chronic kidney disease, was investigated by a few authors. Several groups addressed the eyes' structure and function, neurological conditions, especially headache disorders, and hematological and oncological conditions. Finally, the impact of RF on several aspects of mental health and well-being was addressed by various groups. Conclusions: Health aspects of RF received a sustained academic interest with a broad spectrum in 2021. This narration provides an overview of the year's scholarly health-related literature on various aspects of health and disease. It should help researchers and clinicians catch up quickly with the health concerns during Ramadan.

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“…Sirdharan et al 2021 recently conducted a retrospective study on the impact of Ramadan fasting on INR control 32 and reported no significant difference in the PT‐INR among the three periods. Despite that, significantly higher PT‐INR in post‐Ramadan compared to pre‐ and during Ramadan periods was noticed among the middle‐aged/older adults.…”

Section: Discussionmentioning

confidence: 99%

Does Ramadan fasting disrupt international normalised ratio control in warfarin‐treated medically stable patients?

et al. 2021

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Aim: Warfarin is commonly used in patients with thrombotic diseases. This study aimed to evaluate the impact of Ramadan fasting on warfarin efficacy by investigating international normalised ratio (INR) stability in medically stable patients. Methods: A retrospective observational study was conducted at King Khalid University Hospital during Ramadan 2016 on fasting adult patients aged above 18 years and receiving warfarin. The INR values during pre-Ramadan, Ramadan and post-Ramadan periods were collected after satisfying the inclusion criteria. Time within the therapeutic range (TTR) during the whole period was estimated using the conventional method. Results: In total, 101 patients were included in the study. The mean age (SD) was 55.8 ± 15.5 years, and 52.4% were females. The target INR range for 62.4% was 2-3, while 37.6% had a target INR range of 2.5-3.5. An upward trend in the proportion of patients with therapeutic INR was noticed during Ramadan (59.4%) as compared to pre-(56.4%) and post-Ramadan periods (53.5%) respectively. Additionally, the proportions of patients with supratherapeutic and sub-therapeutic INR were the highest and lowest, 23% and 24% respectively post-Ramadan as compared to other periods. Based on target INR categorisation, achieving therapeutic INR during Ramadan was more feasible with the low INR (2-3) compared to the high INR (2.5-3.5) target patients, 63.5% vs 52.6% respectively. TTR estimation revealed 62.4% and 37.6% of the patients had good and poor, respectively, anticoagulation status throughout the study period. Conclusion: Despite the changes in mean INR and proportion of patients with therapeutic INR during Ramadan compared to other non-fasting months, our results confirmed that short-term fasting during Ramadan has no significant influence on INR stability and, consequently, therapeutic efficacy in warfarin-treated medically stable patients.

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Does fasting during Ramadan influence the therapeutic effect of warfarin?

Cited by 8 publications

References 13 publications

Effect of Ramadan Fasting on the International Normalized Ratio and Prosthetic valve function in Patients with Mechanical Prosthetic Heart Valves

Effect of Ramadan Fasting on the International Normalized Ratio and Prosthetic valve function in Patients with Mechanical Prosthetic Heart Valves

Ramadan Fasting in Health and Disease in 2021: A Narrative Review

Does Ramadan fasting disrupt international normalised ratio control in warfarin‐treated medically stable patients?

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