The effects of fasting in Muslim patients taking warfarin
Summary Background Anticoagulation with warfarin is influenced by dietary changes but the effect of fasting on warfarin therapy is unknown. Objectives To study changes in international normalized ratio (INR) and the percentage of time within therapeutic range (%TTR) before, during and after the Musl...
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| Veröffentlicht in: | Journal of thrombosis and haemostasis 2014-03, Vol.12 (3), p.349-354 |
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| creator | Lai, Y. F. Cheen, M. H. H. Lim, S. H. Yeo, F. H. I. Nah, S. C. Kong, M. C. Mya, D. Lee, L. H. Ng, H. J. |
| description | Summary
Background
Anticoagulation with warfarin is influenced by dietary changes but the effect of fasting on warfarin therapy is unknown.
Objectives
To study changes in international normalized ratio (INR) and the percentage of time within therapeutic range (%TTR) before, during and after the Muslim fasting month (Ramadan) in stable warfarinised Muslim patients.
Methods/Patients
In this prospective study, weekly INR readings were taken at home visits from participating patients during three study periods: before, during and after Ramadan. Readings were blinded to patients and their primary physicians except for when pre‐set study endpoints were reached.
Results
Among 32 participating patients, mean INR increased by 0.23 (P = 0.006) during Ramadan from the pre‐Ramadan month and decreased by 0.28 (P |
| doi_str_mv | 10.1111/jth.12496 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_miscellaneous_1505255764</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>1505255764</sourcerecordid><originalsourceid>FETCH-LOGICAL-c4546-3b7b72071e3d10f8498c3f6ec50fdc054b82a9f826ba5ea3c1b494da0874fcb33</originalsourceid><addsrcrecordid>eNp1kMtOwzAQRS0EoqWw4AdQJDawSOtn4ixRBRRUxKasLcexqUsexU5U9e9xSGGBxGxmpHt0NLoAXCI4RWFmm3Y9RZhmyREYI0Z4nHKSHP_cGSEjcOb9BkKUMQxPwQhTwiiHaAyy1VpH2hitWh81JjLSt7Z-j2wdvXS-tFW0la3VdUhb-dEnO-mMdLY-BydGll5fHPYEvD3cr-aLePn6-DS_W8aKMprEJE_zFMMUaVIgaDjNuCIm0YpBUyjIaM6xzAzHSS6ZlkShnGa0kJCn1KickAm4Gbxb13x22reisl7pspS1bjovEIMMM5YmNKDXf9BN07k6fNdTFOOEpr3wdqCUa7x32oits5V0e4Gg6PsUoU_x3Wdgrw7GLq908Uv-FBiA2QDsbKn3_5vE82oxKL8Asfx9SQ</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>1504226473</pqid></control><display><type>article</type><title>The effects of fasting in Muslim patients taking warfarin</title><source>MEDLINE</source><source>EZB-FREE-00999 freely available EZB journals</source><source>Alma/SFX Local Collection</source><creator>Lai, Y. F. ; Cheen, M. H. H. ; Lim, S. H. ; Yeo, F. H. I. ; Nah, S. C. ; Kong, M. C. ; Mya, D. ; Lee, L. H. ; Ng, H. J.</creator><creatorcontrib>Lai, Y. F. ; Cheen, M. H. H. ; Lim, S. H. ; Yeo, F. H. I. ; Nah, S. C. ; Kong, M. C. ; Mya, D. ; Lee, L. H. ; Ng, H. J.</creatorcontrib><description>Summary
Background
Anticoagulation with warfarin is influenced by dietary changes but the effect of fasting on warfarin therapy is unknown.
Objectives
To study changes in international normalized ratio (INR) and the percentage of time within therapeutic range (%TTR) before, during and after the Muslim fasting month (Ramadan) in stable warfarinised Muslim patients.
Methods/Patients
In this prospective study, weekly INR readings were taken at home visits from participating patients during three study periods: before, during and after Ramadan. Readings were blinded to patients and their primary physicians except for when pre‐set study endpoints were reached.
Results
Among 32 participating patients, mean INR increased by 0.23 (P = 0.006) during Ramadan from the pre‐Ramadan month and decreased by 0.28 (P < 0.001) after Ramadan. There was no significant difference (P = 1.000) in mean INR between the non‐Ramadan months. %TTR declined from 80.99% before Ramadan to 69.56% during Ramadan (P = 0.453). The first out‐of‐range INR was seen around 12.1 days (95% CI, 9.0–15.1) after the start of fasting and returned to range at about 10.8 days (95% CI, 7.9–13.7) after Ramadan. Time above range increased from 10.80% pre‐Ramadan to 29.87% during Ramadan (P = 0.027), while time below range increased from 0.57% during Ramadan to 15.49% post‐Ramadan (P = 0.006). No bleeding or thrombotic events were recorded.
Conclusions
Fasting significantly increases the mean INR of medically stable patients taking warfarin and the likelihood of having an INR above therapeutic targets. For patients maintained at the higher end of INR target ranges or at increased risk of bleeding, closer monitoring or dosage adjustment may be necessary during fasting.</description><identifier>ISSN: 1538-7933</identifier><identifier>ISSN: 1538-7836</identifier><identifier>EISSN: 1538-7836</identifier><identifier>DOI: 10.1111/jth.12496</identifier><identifier>PMID: 24354801</identifier><language>eng</language><publisher>England: Elsevier Limited</publisher><subject>Adult ; Aged ; Aged, 80 and over ; Anticoagulants - administration & dosage ; Atrial Fibrillation - drug therapy ; Fasting ; Female ; Humans ; International Normalized Ratio ; Islam ; Male ; Middle Aged ; Muslim ; Prospective Studies ; Venous Thromboembolism - drug therapy ; warfarin ; Warfarin - administration & dosage ; Young Adult</subject><ispartof>Journal of thrombosis and haemostasis, 2014-03, Vol.12 (3), p.349-354</ispartof><rights>2013 International Society on Thrombosis and Haemostasis</rights><rights>2013 International Society on Thrombosis and Haemostasis.</rights><rights>Copyright © 2014 International Society on Thrombosis and Haemostasis</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c4546-3b7b72071e3d10f8498c3f6ec50fdc054b82a9f826ba5ea3c1b494da0874fcb33</citedby><cites>FETCH-LOGICAL-c4546-3b7b72071e3d10f8498c3f6ec50fdc054b82a9f826ba5ea3c1b494da0874fcb33</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,776,780,27903,27904</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/24354801$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Lai, Y. F.</creatorcontrib><creatorcontrib>Cheen, M. H. H.</creatorcontrib><creatorcontrib>Lim, S. H.</creatorcontrib><creatorcontrib>Yeo, F. H. I.</creatorcontrib><creatorcontrib>Nah, S. C.</creatorcontrib><creatorcontrib>Kong, M. C.</creatorcontrib><creatorcontrib>Mya, D.</creatorcontrib><creatorcontrib>Lee, L. H.</creatorcontrib><creatorcontrib>Ng, H. J.</creatorcontrib><title>The effects of fasting in Muslim patients taking warfarin</title><title>Journal of thrombosis and haemostasis</title><addtitle>J Thromb Haemost</addtitle><description>Summary
Background
Anticoagulation with warfarin is influenced by dietary changes but the effect of fasting on warfarin therapy is unknown.
Objectives
To study changes in international normalized ratio (INR) and the percentage of time within therapeutic range (%TTR) before, during and after the Muslim fasting month (Ramadan) in stable warfarinised Muslim patients.
Methods/Patients
In this prospective study, weekly INR readings were taken at home visits from participating patients during three study periods: before, during and after Ramadan. Readings were blinded to patients and their primary physicians except for when pre‐set study endpoints were reached.
Results
Among 32 participating patients, mean INR increased by 0.23 (P = 0.006) during Ramadan from the pre‐Ramadan month and decreased by 0.28 (P < 0.001) after Ramadan. There was no significant difference (P = 1.000) in mean INR between the non‐Ramadan months. %TTR declined from 80.99% before Ramadan to 69.56% during Ramadan (P = 0.453). The first out‐of‐range INR was seen around 12.1 days (95% CI, 9.0–15.1) after the start of fasting and returned to range at about 10.8 days (95% CI, 7.9–13.7) after Ramadan. Time above range increased from 10.80% pre‐Ramadan to 29.87% during Ramadan (P = 0.027), while time below range increased from 0.57% during Ramadan to 15.49% post‐Ramadan (P = 0.006). No bleeding or thrombotic events were recorded.
Conclusions
Fasting significantly increases the mean INR of medically stable patients taking warfarin and the likelihood of having an INR above therapeutic targets. For patients maintained at the higher end of INR target ranges or at increased risk of bleeding, closer monitoring or dosage adjustment may be necessary during fasting.</description><subject>Adult</subject><subject>Aged</subject><subject>Aged, 80 and over</subject><subject>Anticoagulants - administration & dosage</subject><subject>Atrial Fibrillation - drug therapy</subject><subject>Fasting</subject><subject>Female</subject><subject>Humans</subject><subject>International Normalized Ratio</subject><subject>Islam</subject><subject>Male</subject><subject>Middle Aged</subject><subject>Muslim</subject><subject>Prospective Studies</subject><subject>Venous Thromboembolism - drug therapy</subject><subject>warfarin</subject><subject>Warfarin - administration & dosage</subject><subject>Young Adult</subject><issn>1538-7933</issn><issn>1538-7836</issn><issn>1538-7836</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2014</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp1kMtOwzAQRS0EoqWw4AdQJDawSOtn4ixRBRRUxKasLcexqUsexU5U9e9xSGGBxGxmpHt0NLoAXCI4RWFmm3Y9RZhmyREYI0Z4nHKSHP_cGSEjcOb9BkKUMQxPwQhTwiiHaAyy1VpH2hitWh81JjLSt7Z-j2wdvXS-tFW0la3VdUhb-dEnO-mMdLY-BydGll5fHPYEvD3cr-aLePn6-DS_W8aKMprEJE_zFMMUaVIgaDjNuCIm0YpBUyjIaM6xzAzHSS6ZlkShnGa0kJCn1KickAm4Gbxb13x22reisl7pspS1bjovEIMMM5YmNKDXf9BN07k6fNdTFOOEpr3wdqCUa7x32oits5V0e4Gg6PsUoU_x3Wdgrw7GLq908Uv-FBiA2QDsbKn3_5vE82oxKL8Asfx9SQ</recordid><startdate>201403</startdate><enddate>201403</enddate><creator>Lai, Y. F.</creator><creator>Cheen, M. H. H.</creator><creator>Lim, S. H.</creator><creator>Yeo, F. H. I.</creator><creator>Nah, S. C.</creator><creator>Kong, M. C.</creator><creator>Mya, D.</creator><creator>Lee, L. H.</creator><creator>Ng, H. J.</creator><general>Elsevier Limited</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7T5</scope><scope>H94</scope><scope>K9.</scope><scope>7X8</scope></search><sort><creationdate>201403</creationdate><title>The effects of fasting in Muslim patients taking warfarin</title><author>Lai, Y. F. ; Cheen, M. H. H. ; Lim, S. H. ; Yeo, F. H. I. ; Nah, S. C. ; Kong, M. C. ; Mya, D. ; Lee, L. H. ; Ng, H. J.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c4546-3b7b72071e3d10f8498c3f6ec50fdc054b82a9f826ba5ea3c1b494da0874fcb33</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2014</creationdate><topic>Adult</topic><topic>Aged</topic><topic>Aged, 80 and over</topic><topic>Anticoagulants - administration & dosage</topic><topic>Atrial Fibrillation - drug therapy</topic><topic>Fasting</topic><topic>Female</topic><topic>Humans</topic><topic>International Normalized Ratio</topic><topic>Islam</topic><topic>Male</topic><topic>Middle Aged</topic><topic>Muslim</topic><topic>Prospective Studies</topic><topic>Venous Thromboembolism - drug therapy</topic><topic>warfarin</topic><topic>Warfarin - administration & dosage</topic><topic>Young Adult</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Lai, Y. F.</creatorcontrib><creatorcontrib>Cheen, M. H. H.</creatorcontrib><creatorcontrib>Lim, S. H.</creatorcontrib><creatorcontrib>Yeo, F. H. I.</creatorcontrib><creatorcontrib>Nah, S. C.</creatorcontrib><creatorcontrib>Kong, M. C.</creatorcontrib><creatorcontrib>Mya, D.</creatorcontrib><creatorcontrib>Lee, L. H.</creatorcontrib><creatorcontrib>Ng, H. J.</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>Immunology Abstracts</collection><collection>AIDS and Cancer Research Abstracts</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>MEDLINE - Academic</collection><jtitle>Journal of thrombosis and haemostasis</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Lai, Y. F.</au><au>Cheen, M. H. H.</au><au>Lim, S. H.</au><au>Yeo, F. H. I.</au><au>Nah, S. C.</au><au>Kong, M. C.</au><au>Mya, D.</au><au>Lee, L. H.</au><au>Ng, H. J.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>The effects of fasting in Muslim patients taking warfarin</atitle><jtitle>Journal of thrombosis and haemostasis</jtitle><addtitle>J Thromb Haemost</addtitle><date>2014-03</date><risdate>2014</risdate><volume>12</volume><issue>3</issue><spage>349</spage><epage>354</epage><pages>349-354</pages><issn>1538-7933</issn><issn>1538-7836</issn><eissn>1538-7836</eissn><abstract>Summary
Background
Anticoagulation with warfarin is influenced by dietary changes but the effect of fasting on warfarin therapy is unknown.
Objectives
To study changes in international normalized ratio (INR) and the percentage of time within therapeutic range (%TTR) before, during and after the Muslim fasting month (Ramadan) in stable warfarinised Muslim patients.
Methods/Patients
In this prospective study, weekly INR readings were taken at home visits from participating patients during three study periods: before, during and after Ramadan. Readings were blinded to patients and their primary physicians except for when pre‐set study endpoints were reached.
Results
Among 32 participating patients, mean INR increased by 0.23 (P = 0.006) during Ramadan from the pre‐Ramadan month and decreased by 0.28 (P < 0.001) after Ramadan. There was no significant difference (P = 1.000) in mean INR between the non‐Ramadan months. %TTR declined from 80.99% before Ramadan to 69.56% during Ramadan (P = 0.453). The first out‐of‐range INR was seen around 12.1 days (95% CI, 9.0–15.1) after the start of fasting and returned to range at about 10.8 days (95% CI, 7.9–13.7) after Ramadan. Time above range increased from 10.80% pre‐Ramadan to 29.87% during Ramadan (P = 0.027), while time below range increased from 0.57% during Ramadan to 15.49% post‐Ramadan (P = 0.006). No bleeding or thrombotic events were recorded.
Conclusions
Fasting significantly increases the mean INR of medically stable patients taking warfarin and the likelihood of having an INR above therapeutic targets. For patients maintained at the higher end of INR target ranges or at increased risk of bleeding, closer monitoring or dosage adjustment may be necessary during fasting.</abstract><cop>England</cop><pub>Elsevier Limited</pub><pmid>24354801</pmid><doi>10.1111/jth.12496</doi><tpages>6</tpages><oa>free_for_read</oa></addata></record> |
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| subjects | Adult Aged Aged, 80 and over Anticoagulants - administration & dosage Atrial Fibrillation - drug therapy Fasting Female Humans International Normalized Ratio Islam Male Middle Aged Muslim Prospective Studies Venous Thromboembolism - drug therapy warfarin Warfarin - administration & dosage Young Adult |
| title | The effects of fasting in Muslim patients taking warfarin |
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