The Effect of Ramadan Fasting on Oral Anticoagulant: Experience of Tertiary Academic Hospital

Direct oral anticoagulants (DOACs) have been approved for stroke prevention in non-valvular atrial fibrillation (AF). The outcomes achieved by clinical trials depend on pharmacokinetics and pharmacodynamics of these drugs which are used orally in regular doses once or twice daily. During our routine practice we face an obligatory choice to prescribe NOAC twice daily during the month of Ramadan. Twice daily dose drugs in our practice as well as with Muslim patients everywhere in the world during the holy month of Ramadan. Objective: to evaluate the effectiveness and safety of NOACs either once daily or twice daily used during the month of Ramadan for stroke prevention in Non-Valvular atrial fibrillation. Methods: An observational study in tertiary university hospital at Saudi Arabia for 114 patient’s non-valvular atrial fibrillation on NOACs during the month of Ramadan 1441 H/ 2019 with laboratory follow ups before Ramadan and one month after for each patient who completed at least 15 days fasting during this Holy month of Ramadan 1441 H/ 2019. Results: 114 patients, 40 were on Rivaroxaban and 74 on Dabigatran, the baseline characteristic are similar except the history of myocardial infarction 28%, and Heart failure 58% in the Rivaroxaban arm which was higher than the Dabigatran arm 9%, & 12%. Regarding the concomitant medications used Aspirin in Rivaroxaban arm 33%, Dabigatran arm 11%, NSAID only Dabigatran arm 8%, %, no significant deferent in the stroke and bleeding events between two arms. Conclusion: The data shows that the Direct oral anticoagulant are effective and safe to be used in Ramadan for non-valvular atrial fibrillation regardless the frequency of anticoagulant , further studies are needed to support these findings in non-valvular atrial fibrillation and other indications.