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

Alwhaibi, Abdulrahman; Alenazi, Miteb; Alwagh, Fouzia; Al-Ghayhab, Abdullatif; Alghadeer, Sultan; Bablghaith, Salmeen; Wajid, Syed; Al-Arifi, Mohammed N.

doi:10.1111/ijcp.14796

Cited by 5 publications

(5 citation statements)

References 26 publications

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“…An upward trend in the proportion of patients with therapeutic INR was noticed during Ramadan (59.4%) as compared with the pre- (56.4%) and post-Ramadan periods (53.5%), respectively. 79 Additionally, the proportions of patients with supratherapeutic and subtherapeutic INR were the highest and lowest, 23 and 24%, respectively, post-Ramadan compared with other periods. Based on target INR categorization, achieving therapeutic INR during RF was more feasible with the low INR (2–3) compared with the high INR (2.5–3.5) target patients, 63.5% versus 52.6%, respectively.…”

Section: Resultsmentioning

confidence: 87%

“…Finally, the target INR range for 62.4% was 2 to 3, while 37.6% had a target INR range of 2.5 to 3.5. An upward trend in the proportion of patients with therapeutic INR was noticed during Ramadan (59.4%) as compared with the pre-(56.4%) and post-Ramadan periods (53.5%), respectively 79. Additionally, the proportions of patients with supratherapeutic and subtherapeutic INR were the highest and lowest, 23 and 24%, respectively, post-Ramadan compared with other periods.…”

mentioning

confidence: 82%

“…The three studies that considered the acute disturbances of hematological conditions were related to anticoagulation therapy during RF. [77][78][79] RF effect on the international normalized ratio (INR) variations was assessed in 30 patients (mean age 65 years; equal sex) treated with acenocoumarol in a prospective monocentric study. 77 Mean INR was significantly higher during RF than baseline (3.51 vs. 2.52; p < 0.0001).…”

Section: Acute Hematological Conditionsmentioning

confidence: 99%

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Burden and Patterns of Medical Emergencies during Ramadan Fasting: A Narrative Review

Beshyah

Elamouri

Almagdub

et al. 2023

Ibnosina Journal of Medicine and Biomedical Sciences

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Introduction Acute medical problems may occur more frequently during Ramadan fasting (RF). We aimed to provide a narrative overview of the global literature on medical emergencies during RF. Methods This is a nonsystematic review of the international literature from one major medical online database (PubMed, National Institutes of Health, United States). The relevant literature was narrated in a concise thematic account. Results There is a variable impact in the burden and time distribution of emergency services and hospitalization during RF that may require readjustment of resource allocation. Studies of the risk of accidents and injuries may be increased overall or at specified times, around Iftar time. A classical impact of emergencies has been the risk of worsening peptic ulcer disease. RF impacts diabetic emergencies such as severe hypoglycemia, hyperglycemia, and diabetic ketoacidosis, particularly in type 1 diabetes and poorly controlled patients. Glucocorticoid replacement therapy may represent a challenge to patients and physicians that require education and dose adjustment. Acute neurological conditions of interest include the “first day of Ramadan headache,” epilepsy, and strokes. Several studies evaluated the risk of the acute coronary syndrome and heart failure with inconsistent findings. RF may impact the renal and urological systems through stone disease, renal colic, and acute kidney. The impact on hematological conditions was mostly focused on the safety of anticoagulant therapy during Ramadan. Conclusion The review addresses the emergency medical encounters of the fasting patient during Ramadan to allow a holistic and ethnically sensitive approach to medical care under circumstances where decisions have to be taken with no delay.

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Section: Resultsmentioning

confidence: 87%

mentioning

confidence: 82%

Section: Acute Hematological Conditionsmentioning

confidence: 99%

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Burden and Patterns of Medical Emergencies during Ramadan Fasting: A Narrative Review

Beshyah

Elamouri

Almagdub

et al. 2023

Ibnosina Journal of Medicine and Biomedical Sciences

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“…RF influences the therapeutic effect of warfarin in terms of lowered TTR (%), reduced proportion of patients achieving therapeutic PT-INR, and increased risk of poor anticoagulation control. Also, Alwhaibi et al 52 evaluated the impact of RF on warfarin efficacy by investigating INR stability in medically stable patients. A retrospective observational study was conducted during Ramadan 2016 on fasting adult patients aged above 18 years and receiving warfarin.…”

Section: Highlights Of the Year's Literaturementioning

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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“…Available studies on the effect of Fasting on the INR-were conducted in different geographic areas of the world. These studies included diverse patient populations with widely variable cultural & social backgrounds and ended up with inconsistent results (7).…”

Section: Introductionmentioning

confidence: 99%

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

Cited by 5 publications

References 26 publications

Burden and Patterns of Medical Emergencies during Ramadan Fasting: A Narrative Review

Burden and Patterns of Medical Emergencies during Ramadan Fasting: A Narrative Review

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

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

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