Department of Clinical Pharmacy, King Saud University, Riyadh, Saudi Arabia.
Pharmacy Department, King Saud University Medical City (KSUMC), Riyadh, Saudi Arabia.
Int J Clin Pract. 2021 Nov;75(11):e14796. doi: 10.1111/ijcp.14796. Epub 2021 Sep 15.
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.
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.
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.
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.
华法林常用于血栓性疾病患者。本研究旨在通过调查医学稳定患者的国际标准化比值（INR）稳定性，评估斋月禁食对华法林疗效的影响。
在 2016 年斋月期间，我们对在 King Khalid 大学医院接受华法林治疗的成年禁食患者进行了一项回顾性观察性研究。在满足纳入标准后，收集了斋月前、斋月中和斋月后患者的 INR 值。采用常规方法估计整个时期的治疗范围内时间（TTR）。
共纳入 101 例患者。平均年龄（SD）为 55.8±15.5 岁，52.4%为女性。62.4%的目标 INR 范围为 2-3，37.6%的目标 INR 范围为 2.5-3.5。与斋月前（56.4%）和斋月后（53.5%）相比，斋月期间有治疗性 INR 的患者比例呈上升趋势（59.4%）。此外，斋月后超治疗和低于治疗的 INR 患者比例最高和最低，分别为 23%和 24%。根据目标 INR 分类，与高 INR（2.5-3.5）目标患者相比，低 INR（2-3）的患者在斋月期间达到治疗性 INR 更具可行性，分别为 63.5%和 52.6%。TTR 估计显示，62.4%和 37.6%的患者在整个研究期间分别具有良好和较差的抗凝状态。
尽管与其他非禁食月份相比，斋月期间 INR 的平均值和具有治疗性 INR 的患者比例发生了变化，但我们的结果证实，斋月期间的短期禁食对华法林治疗的医学稳定患者的 INR 稳定性和治疗效果没有显著影响。
