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

Alghamdi, Mohammed G.; Kokandi, Abdullah Adel; Alfadhil, Rheema; Alotaibi, Lama Abdullah

doi:10.5455/umj.20180117091224

Cited by 7 publications

(6 citation statements)

References 8 publications

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“…Alghamdi et al [69] evaluated the effect of RF on the international normalized ratio (INR) stability in patients using warfarin anticoagulation for mechanical prosthetic heart valves. Data were extracted retrospectively from a specialized anticoagulation clinic electronic database and were analyzed in a case-control manner, where Ramadan INR of each study subject was compared to his/her own pre-Ramadan INR level.…”

Section: Vascular Disease and Risk Factorsmentioning

confidence: 99%

The Year in “Ramadan Fasting and Health” (2018): A Narrative Review

Beshyah

Badi²,

Elghul

et al. 2019

Ibnosina Journal of Medicine and Biomedical Sciences

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Invited Review introduCtionRamadan fasting (RF) is practiced by adult Muslims during the 9 th lunar month every year. It entails that they abstain from eating and drinking between dawn and sunset. Medical and religious scholars got closer in their approach to advice given to patients based on objective risk assessment. [1] Muslim patients with acute or chronic medical conditions may be exempted from fasting; many do still choose to observe the fast sometimes against medical advice. This may adversely affect their health if not addressed properly by evidence-based recommendations. [2] There has been a tremendous recent interest in the health implications of RF. Keeping up with developments in this area may prove difficult, and hence, a narrative overview under a single cover may be particularly useful in presenting a digest of the research and expert opinion in the year. [3] Our previous review of the literature published in 2017 was the most viewed Introduction: There has been an increased interest in health implications of Ramadan fasting (RF). Materials and Methods: This is a narrative, nonsystematic review of the literature including all relevant full articles in English in three electronic databases (Scopus, PubMed, and Google Scholar). The search term "Ramadan fasting" was used to identify the relevant records to provide a readily comprehensible concise account of the contributions made to research and clinical practice in 1 year (2018). Results: The publications spanned basic, clinical, ethical, professional, and cultural and advocacy facets of the subject. The publications crossed the conventional disciplinary lines and geographical locations and appeared in journals with varying systems of access. Only full-text research articles in English were reviewed. Review articles, news, note items, and correspondence were not included. No formal bibliometric analysis is presented. Emerging concepts are presented under the relevant subheading depending on the available literature. Impact of RF on diabetes control, pregnancy outcome and fetal life, and sports and athletes' well-being received somewhat more prominent coverage by research work published in 2018. Renovascular disease, and risk factors, posttransplant care, and some metabolic concerns for patients with hepatic, renal, and metabolic conditions were covered too. Patterns of use of emergency services during Ramadan and features of some specific medical emergencies were examined by some workers. Most interesting perhaps was the greater focus on documenting the perception, attitudes, and practices of both patients and healthcare professions regarding deciding and acting during Ramadan. Isolated research reports addressed subjects of wide nature from body composition and energy metabolism to smoking, law, music, and history. Conclusions: The volume of scholarly work on Ramadan fasting and health remains modest. Greater improvements in both quality and quantity of research on Ramadan are needed. Most studies indicate that Ramadan fasting is safe in mild and st...

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Section: Vascular Disease and Risk Factorsmentioning

confidence: 99%

The Year in “Ramadan Fasting and Health” (2018): A Narrative Review

Beshyah

Badi²,

Elghul

et al. 2019

Ibnosina Journal of Medicine and Biomedical Sciences

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show abstract

“…However, a study of Awiwi et al, (9), while contradicting our results regarding INR changes during Ramadan, noticed fluctuations in the quality of anticoagulation throughout their study, with the largest fluctuation in the ratio of patients with optimal therapeutic anticoagulation observed between Ramadan and the first week post-Ramadan (87.5% vs. 60.0%). On the other hand, a study concluded that mean INR insignificantly decreased during Ramadan compared to pre-Ramadan, despite fluctuations in INR results during Ramadan, with 66% of patients within the desired therapeutic range during Ramadan, down from 74% pre-Ramadan (12). During Ramadan, there was an increase in out-of-range INR values, particularly in the supra-therapeutic direction, affecting both high and low target INR groups.…”

Section: Discussionmentioning

confidence: 97%

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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“…Alghamdi et al 2018 published a retrospective study on the effect of Ramadan fasting on the INR level in Saudi patients using warfarin for prosthetic heart valve anticoagulation 4 . They found no difference in the INR at baseline (pre‐Ramadan) compared to Ramadan.…”

Section: Discussionmentioning

confidence: 99%

“…During Ramadan, most adult Muslims abstain from eating and drinking from dawn to sunset, which is considered short-term fasting [1][2][3] and called "Siyam." 4 Although fasting is not obligatory for individuals with health issues, a majority of patients, including those with thrombotic diseases, choose to fast during Ramadan to observe the spirituality of this month. Food abstinence applies to everything reaching the stomach, including oral medications such as warfarin.…”

Section: Introductionmentioning

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

Cited by 7 publications

References 8 publications

The Year in “Ramadan Fasting and Health” (2018): A Narrative Review

The Year in “Ramadan Fasting and Health” (2018): A Narrative Review

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

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

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