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  • Ask the doctor: I have reduced my drinking from seven nights a week to three – and lost 4kg in a month - planetcirculate

    Ask the doctor: I have reduced my drinking from seven nights a week to three – and lost 4kg in a month



    Question: I am a man who just turned 50 and I recently started medication for atrial fibrillation. I have lost a lot of weight since I started the medication — like 4kg in around a month, and I was wondering if this is connected to the medication. I also reduced my drinking to three nights a week from seven, so maybe this would result in weight loss? My appetite has not diminished at all so I am not eating less. I had a beer belly so I did have weight to lose. What do you think?

    Dr Grant replies: The broad term anticoagulant or “blood thinner” is used when talking about patients who have been diagnosed with an ‘irregular heartbeat’ such as atrial fibrillation (AF), which is the most commonly treated cardiac arrhythmia.

    The risk of developing AF increases with age, as approximately 70pc of cases are seen in patients aged 65 and older. The prevalence is slightly higher in men versus women. There is an association in patients with hypertensive and coronary heart disease that is complicated by heart attack (acute myocardial infarction) or heart failure.

    Other associations include family history, diabetes, chronic kidney disease, hyperthyroidism, valvular heart disease, congenital heart disease and hypertrophic cardiomyopathy (enlargement of the heart). Patients with obesity are significantly more likely to develop AF.

    In your case, alcohol is both a chronic risk factor for the development of AF and an acute trigger for AF episodes. Most acute cases of AF occur during weekends or holidays when alcohol intake is increased, a phenomenon termed “the holiday heart syndrome.” So I am glad to read that you are now only drinking three nights per week, but perhaps you might be able to go one step further and consider stopping alcohol altogether?

    One of the main indications for use of a blood thinner is for stroke prevention in patients with AF. With the advent of new drug developments over the past two decades, there are now fewer people being prescribed the traditional anticoagulant warfarin (which is a vitamin K antagonist).

    Thanks to pharmaceutical investment and research, we have much safer and more effective anticoagulants available today. Orally active direct factor Xa inhibitors include rivaroxaban (Xarelto), apixaban (Eliquis), and edoxaban (Lixiana). Dabigatran (Pradaxa) is the only orally active direct thrombin inhibitor (DTI).

    All anticoagulants increase bleeding risk. The other main risk to be aware of is the risk of thrombosis (forming a blood clot somewhere in your body) upon discontinuation. These newer blood thinners are primarily excreted in the kidney. You should know your kidney function as a baseline before starting the medication, as there may be a need for potential dose adjustment in the event of reduced kidney function. Dose adjustments are also required for liver disease.

    Finally, in answer to your question, no I do not think your newly prescribed heart medication has caused your recent weight loss, as it is not a known side effect. However, I reckon your significantly reduced alcohol intake has caused your most welcome recent weight loss.

    Dr Jennifer Grant is a GP with Beacon HealthCheck



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