Eliquis Doesn't Cause As Much Incidental Bruising As Coumadin
DEAR DR. ROACH: In 1998, I was diagnosed with lupus anticoagulant and was put on Coumadin. I tolerated it well. A couple of years ago, I was changed to Eliquis, which I also tolerate well.
I noticed that when I was on Coumadin, I would find bruising on me that I didn't realize I had until I saw the bruising visually. With Eliquis, I don't notice the same sort of incidental bruising. My doctor attributed the difference to the nature of the medicines and the way they work. Do you concur with this observation? -- L.J.
ANSWER: In general, fewer people notice bruising on directly acting oral anticoagulants (DOACs) like apixaban (Eliquis) than with the older warfarin (Coumadin). Part of this may be that the levels of apixaban are very consistent, while the dose of warfarin often needs to be adjusted as the person's levels gets too high (more bruising, even with minor trauma) or too low (more chance of a clot). DOACs are much more often used now than warfarin for most purposes.
People with clotting and antiphospholipid syndrome (aka lupus anticoagulant, which is misnamed since it actually promotes clotting) are still more commonly treated with warfarin, although DOACs are sometimes used by experts. Mechanical heart valves are not treated with DOACs.
DEAR DR. ROACH: I had a colonoscopy performed, and my doctor noted that I had a "tortured colon." His answer was somewhat vague when I asked what caused this condition and if there was anything I could do to mitigate it. Can you give me any more information about this condition? -- L.S.
ANSWER: Here is an example of poor communication since I am sure that he meant a "tortuous colon," also called a redundant colon. This is when the colon is unusually long, leading to many "tortuosities," which are simply curves or turns in the colon.
The diagnosis is commonly made after a colonoscopy shows more twists than usual, which can make for a difficult exam. Although some people have no symptoms at all, others have more constipation, abdominal discomfort or bloating. The presence of a tortuous colon does not change the management of these symptoms, which usually starts with a healthy diet, regular exercise, and sometimes fiber supplementation.
People with symptoms that don't respond to these simple changes might benefit from an expert in irritable bowel syndrome (IBS). Even though they are different conditions, the treatments that are used for IBS with constipation are similar to the ones for a tortuous colon. Rarely, people with a tortuous colon develop a twisting of the bowel on its axis called volvulus, which requires urgent intervention.
DEAR DR. ROACH: I'm a 63-year-old male nonsmoker. Two years ago, I started to notice a whitish bump on top of my tongue. My dentist says to keep an eye on it, and my dermatologist says that he does not do anything in the mouth. It is not large but has grown in size; it's not bothersome and not really noticeable.
I think I would like to get it removed. Do you know what this is, what might cause it, and who is the best person to get it evaluated? -- J.L.
ANSWER: I can't really make a diagnosis from your description, but if your dentist isn't recommending a biopsy, then they think it is a benign lesion, like a fibroma (often related to trauma) or keratosis (also related most commonly to trauma).
I would not rush to get it removed, but an oral surgeon is most likely able to make a presumptive diagnosis by looking at it. They may also recommend a biopsy or removal to be sure.
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Dr. Roach regrets that he is unable to answer individual letters, but will incorporate them in the column whenever possible. Readers may email questions to ToYourGoodHealth@med.cornell.edu.
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