BibTex RIS Kaynak Göster

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

Yıl 2018, , 78 - 84, 01.04.2018
https://doi.org/10.5455/umj.20180117091224

Öz

Background: Maintaining a therapeutic range of International Normalized Ratio INR in patients with mechanical prosthetic heart valves is of paramount importance. The effect of religious Fasting and altered lifestyle pattern during the Holy month of Ramadan on the INR stability has not been previously studied in the Saudi population. Objectives: We aimed to evaluate the effect of Ramadan fasting on the INR stability in patients using warfarin anticoagulation for mechanical prosthetic heart valves. Design: Data were extracted retrospectively from a specialized anticoagulation clinic electronic database and were anlysed in a case-control manner, where Ramadan INR of each study subject was compared to his/her own pre-Ramadan INR level. Setting: Prosthetic Valve Anticoagulation Clinic at King Abdul-Aziz Cardiac Center, Riyadh. Materials and methods: Using Point-Of-Care POC testing, the first INR level during Ramadan as compared to the average baseline INR readings over the last 3 months before Ramadan. The study was conducted between July 29th and August 20th, 2015, which corresponds to the month of Ramadan, 1436 Hejra Calendar. Several exclusion criteria were applied to minimize the effects of potential confounding factors. Main Outcome measures: Paired t-test was used to detect any statistically significant difference in the INR level between Ramadan and pre-Ramadan readings, in the overall study cohort and among pre-specified study subgroups. Results: One-hundred and fourteen 114 consecutive patients fulfilled the inclusion criteria. Mean age was 48.4±13.6 years and males constituted 58% of cases. Low target INR: 2.0-3.0 and high target INR: 2.5-3.5 therapeutic ranges represented 35% and 65% respectively. Mean INR level was 2.81 at baseline and 2.75 during Ramadan with no statistically significant difference between them P=NS . Achieving the desired target INR level before Ramadan was feasible in 62.5% and 64.8% of the low and high INR target groups respectively. However, maintaining the desired INR level during Ramadan was feasible in 67.5% and 51.3% of the low and high target INR groups respectively P= 0.07 . Duration of anticoagulation, warfarin dose, and adherence scale did not contribute significantly to the primary outcome. Conclusion: Ramadan fasting and its associated lifestyle changes in the Saudi community may aggravate the INR fluctuations in warfarin-treated patients. During Ramadan, warfarin-treated patients are more prone to develop supra-therapeutic INR and therefore they deserve careful attention and closer INR monitoring.

Kaynakça

  • 1. Desilver DM. World’s Muslim population more widespread than you might think: Pew Research Center; 2017 [updated January 31, 2017]. Available: http:// pewrsr.ch/116QRmk.
  • 2. El-Ashi A. Fasting in Islam: ISlamic Society of Rutgers University. Available from: http://www.eden.rutgers.edu /muslims/fasting.htm.
  • 3. GP Aurigemma BK, WH Gaasch. Antithrombotic therapy in patients with prosthetic heart valves: UpToDate; 2013 [updated Dec 05, 2013]. Available: https://www.uptodate. com/contents/antithrombotic-therapy-for-prosthetic-heartvalves-indications.
  • 4. Holmes MV, Hunt BJ, Shearer MJ. The role of dietary vitamin K in the management of oral vitamin K antagonists. Blood Rev. 2012;26(1):1-14.
  • 5. Addad F, Amami M, Ibn Elhadj Z, Chakroun T, Marrakchi S, Kachboura S. Does Ramadan fasting affect the intensity of acenocoumarol-induced anticoagulant effect?Br J Haematol. 2014;166(5):792-4.
  • 6. Lai YF, Cheen MH, Lim SH, Yeo FH, Nah SC, Kong MC, et al. The effects of fasting in Muslim patients taking warfarin. J Thromb Haemost. 2014;12(3):349-54.
  • 7. Awiwi MO, Yagli ZA, Elbir F, Aglar AA, Guler E, Vural U. The effects of Ramadan fasting on patients with prosthetic heart valve taking warfarin for anticoagulation. J Saudi Heart Assoc. 2017;29(1):1-6.
  • 8. Rifaie O, Sami A, Hamada AH, Ashraf A, Nammas W. Intermittent fasting and laboratory findings in patients with prosthetic valves. Anadolu Kardiyol Derg. 2013;13(2):189.
  • 9. NGHA. Point of Care Services 2014 [updated August 17, 2014]. Available: http://ngha.med.sa/English/Medical Cities/ AlRiyadh/MedicalServices/Lab/Services/Pages/PointofCareS ervices.aspx.
  • 10. Shoeb M, Fang MC. Assessing bleeding risk in patients taking anticoagulants. J Thromb Thrombolysis. 2013;35 (3):312-9.
  • 11. McArthur MC, Dzintars EK, Phillips RB, Bushardt RL. Oral anticoagulation: a review of the current and emerging therapies. JAAPA. 2011;24(11):60-6.
  • 12. Mayet AY. Patient adherence to warfarin therapy and its impact on anticoagulation control. Saudi Pharm J. 2016; 24(1):29-34.
Yıl 2018, , 78 - 84, 01.04.2018
https://doi.org/10.5455/umj.20180117091224

Öz

Kaynakça

  • 1. Desilver DM. World’s Muslim population more widespread than you might think: Pew Research Center; 2017 [updated January 31, 2017]. Available: http:// pewrsr.ch/116QRmk.
  • 2. El-Ashi A. Fasting in Islam: ISlamic Society of Rutgers University. Available from: http://www.eden.rutgers.edu /muslims/fasting.htm.
  • 3. GP Aurigemma BK, WH Gaasch. Antithrombotic therapy in patients with prosthetic heart valves: UpToDate; 2013 [updated Dec 05, 2013]. Available: https://www.uptodate. com/contents/antithrombotic-therapy-for-prosthetic-heartvalves-indications.
  • 4. Holmes MV, Hunt BJ, Shearer MJ. The role of dietary vitamin K in the management of oral vitamin K antagonists. Blood Rev. 2012;26(1):1-14.
  • 5. Addad F, Amami M, Ibn Elhadj Z, Chakroun T, Marrakchi S, Kachboura S. Does Ramadan fasting affect the intensity of acenocoumarol-induced anticoagulant effect?Br J Haematol. 2014;166(5):792-4.
  • 6. Lai YF, Cheen MH, Lim SH, Yeo FH, Nah SC, Kong MC, et al. The effects of fasting in Muslim patients taking warfarin. J Thromb Haemost. 2014;12(3):349-54.
  • 7. Awiwi MO, Yagli ZA, Elbir F, Aglar AA, Guler E, Vural U. The effects of Ramadan fasting on patients with prosthetic heart valve taking warfarin for anticoagulation. J Saudi Heart Assoc. 2017;29(1):1-6.
  • 8. Rifaie O, Sami A, Hamada AH, Ashraf A, Nammas W. Intermittent fasting and laboratory findings in patients with prosthetic valves. Anadolu Kardiyol Derg. 2013;13(2):189.
  • 9. NGHA. Point of Care Services 2014 [updated August 17, 2014]. Available: http://ngha.med.sa/English/Medical Cities/ AlRiyadh/MedicalServices/Lab/Services/Pages/PointofCareS ervices.aspx.
  • 10. Shoeb M, Fang MC. Assessing bleeding risk in patients taking anticoagulants. J Thromb Thrombolysis. 2013;35 (3):312-9.
  • 11. McArthur MC, Dzintars EK, Phillips RB, Bushardt RL. Oral anticoagulation: a review of the current and emerging therapies. JAAPA. 2011;24(11):60-6.
  • 12. Mayet AY. Patient adherence to warfarin therapy and its impact on anticoagulation control. Saudi Pharm J. 2016; 24(1):29-34.
Toplam 12 adet kaynakça vardır.

Ayrıntılar

Birincil Dil İngilizce
Bölüm Research Article
Yazarlar

Mohammed Ghormalla Alghamdi Bu kişi benim

Abdullah Adel Kokandi Bu kişi benim

Rheema Ahmad Alfadhil Bu kişi benim

Lama Abdullah Alotaibi Bu kişi benim

Yayımlanma Tarihi 1 Nisan 2018
Yayımlandığı Sayı Yıl 2018

Kaynak Göster

Vancouver Alghamdi MG, Kokandi AA, Alfadhil RA, Alotaibi LA. Effect of Ramadan Fasting on the International Normalized Ratio in Patients with Mechanical Prosthetic Heart Valves. ULUTAS MED J. 2018;4(2):78-84.