Dr. Keith Roach

DEAR DR. ROACH: I am 54 years old, and I was diagnosed with atrial fibrillation that comes and goes. I was prescribed Xarelto, but since I am scheduled to have a colonoscopy done soon, I asked my cardiologist if I can start the medication after the procedure. She agreed, but I am still a little concerned. Can you please help me? I know that if I do start the medication, I will have to stop for a while until the procedure is completed. — S.R.
ANSWER: AFib is an abnormality of the heart rhythm. Because of the lack of coordinated movement, clots can form in the heart and sometimes spread to the brain, causing a stroke. People with AFib benefit from medicine to reduce the risk of blood clotting. Although some people can be treated with aspirin, most require anticoagulants. Anticoagulants, like Xarelto, reduce stroke risk. However, they have to be stopped before undergoing most surgical procedures.
A screening colonoscopy is usually performed now without stopping an anticoagulant like Xarelto. If a procedure (such as the removal of a large polyp) is expected during the colonoscopy, then anticoagulation is usually stopped a day or two before the procedure.
Far too often, anticoagulation is stopped excessively, and this results in many strokes. Coordination between your regular doctor, or your cardiologist, and the gastroenterologist performing the colonoscopy is essential.
DEAR DR. ROACH: I am a 74-year-old woman, and after getting COVID, I have experienced low iron levels. After my last physical, it was suggested for me to take an iron supplement three days a week, but it caused terrible constipation. I was using a 65 mg iron supplement. I am now trying an 18 mg chelated iron supplement and using fiber and prune juice three days a week. The constipation has improved with that regimen.
Which is better — regular iron supplements or chelated iron supplements? — Anon.
ANSWER: Chelated iron is chemically bound to other compounds, such as amino acids. These have the effect of improving absorption and reducing gastrointestinal symptoms. In a study comparing a chelated iron supplement to a regular iron supplement, both effectively treated iron deficiency, but chelated iron did so faster and with fewer side effects.
Chelated iron may be a good option for people with an upset stomach or constipation. However, be careful of the dosing. You need more than three chelated iron tablets to get the same amount of iron that is in one non-chelated iron tablet, as you described above. About 65 mg of elemental iron every other day is a standard regimen for people with a significant iron deficiency.
A wise physician always considers the possible causes of iron loss in any person with iron deficiency anemia. In a 74-year-old, that must include colon polyps and cancers, so it’s critical that you are up-to-date with your colon cancer screenings.
Low iron levels were found in 90% of hospitalized COVID patients, but it’s not clear whether COVID interfered with iron metabolism or whether people with low iron are at a higher risk for severe COVID (or both). About 30% of patients hospitalized for COVID had persistent iron deficiency after infection.
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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 or send mail to 628 Virginia Dr., Orlando, FL 32803.
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