ORIGINAL RESEARCH article
Front. Pharmacol.
Sec. Drugs Outcomes Research and Policies
Volume 16 - 2025 | doi: 10.3389/fphar.2025.1565094
Safety and effectiveness of apixaban use for stroke prevention during Ramadan fasting (The API-Ram Study)
Provisionally accepted
Aiman Ghrab1*
Rania Gargouri1*
faouzi addad2anis cheikhrouhou1mariem jabeur1
Salma Charfeddine1
AMINE BAHLOUL1
Zied Triki1
Tarek Ellouze1
Omar Abidi2Souad Mallek1Faten Triki1
Salem ABDESSALEM3ismail elalamy4
Leila Abid1*- 1Hopital Universitaire Hedi Chaker, Sfax, Tunisia
- 2Hannibal Clinic, Tunis, Tunisia
- 3Clinic Pasteur, Tunis, Tunisia
- 4Service d'Hématologie Biologique, Hôpital Tenon, Paris, France
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Patients receiving anticoagulation for atrial fibrillation (AF) are required to consult their doctor before starting Ramadan to get his authorization for fasting and adapt their treatment. More often, a once daily regimen is proposed to facilitate their intake schedule. Apixaban, a direct oral anticoagulant, prescribed twice daily with an optimal benefit/risk ratio in numerous situations, has very limited data on its use during Ramadan.To evaluate the safety and the efficacy of apixaban for stroke prevention in AF patients during the month of Ramadan.Methods: An observational, multicentric study was performed in Tunisia during two consecutive years during the specific month of Ramadan. The API-Ram study included AF patients who were on apixaban and fasted at least 10 days. Efficacy was defined by the absence of ischemic events and safety was established with bleeding events occurrence classified via the BARC classification during the study period.Results: A total of 257 patients were included in our study. No ischemic events were reported during the study period. Minor bleeding events were reported in only 12 patients (4.7%) with not any major bleeding event. Based on multivariate analysis, independent predictors for bleeding risk of our population were smoking, history of hypertension and creatinine clearance.Apixaban seems to be safe and effective for the prevention of thromboembolic episode in AF patients during Ramadan fasting. Larger studies such as randomized clinical trials are necessary to confirm these results.
Keywords: apixaban, Atrial Fibrillation, Ramadan fasting, Stroke, Anticoagulants
Received: 04 Mar 2025; Accepted: 18 Jul 2025.
Copyright: © 2025 Ghrab, Gargouri, addad, cheikhrouhou, jabeur, Charfeddine, BAHLOUL, Triki, Ellouze, Abidi, Mallek, Triki, ABDESSALEM, elalamy and Abid. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence:
Aiman Ghrab, Hopital Universitaire Hedi Chaker, Sfax, Tunisia
Rania Gargouri, Hopital Universitaire Hedi Chaker, Sfax, Tunisia
Leila Abid, Hopital Universitaire Hedi Chaker, Sfax, Tunisia
Disclaimer: All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.