• Mohammed AlSheef, Mastourah Alotaibi, Abdul Rehman Z Zaidi, Areej Alshamrani, Aroub Alhamidi, Syed Ziauddin A Zaidi, Noor Alanazi, Sarah Alhathlool, Ohoud Alarfaj, Mohammed AlHazzaa, Ghaydaa Kullab, Amany Alboghdadly, and Amani Abu-Shaheen.
• Department of Medicine, King Fahad Medical City, Riyadh, Kingdom of Saudi Arabia. E-mail. malsheef@kfmc.med.sa.
• Saudi Med J. 2020 Oct 1; 41 (10): 1063-1069.

ObjectivesTo identify the epidemiologic profile of cerebral vein thrombosis (CVT) among fasting women using oral contraceptive pills  (OCPs) during the holy month of Ramadan. Methods: This retrospective study was conducted on all patients diagnosed with CVT and using OCPs from records at a tertiary care hospital in Riyadh, Saudi Arabia during 2016-2017. The study participants were categorized into 2 groups (an intermittently fasting group during the holy month of Ramadan and a non-fasting group).  Results: Out of 108 female patients with CVT, 36.1% were secondary to OCP, of whom 41% participants were fasting. The most affected site was the transverse sinus. Holocephalic headache was more common amongst fasting group (68.8%) compared to non-fasting group (30.4%) (p=0.025). Dehydration (p=0.003) amongst the fasting group and protein S deficiency (p=0.027) in the non-fasting group were identified as the 2 prominent risk factors. Unfractionated heparin was the most common anticoagulant therapies used during the initiation phase for non-fasting (36.4%) and fasting groups (50%). Conclusion: All women who are using OCP should undergo formal written risk assessments for factors of CVT. Our study suggests that the negative effects of OCPs use might outweigh its benefits; thus, it should be prescribed with caution, more so in fasting patients.

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