Your Good Health: Purpura spots appear as skin begins to get thinner

Dear Dr. Roach: I am an 84-year-old man and have had atrial fibrillation for many years. In 2022, I had the WATCHMAN procedure. Prior to the WATCHMAN implant, I took Eliquis to help prevent strokes. During this time, I never had an issue with purpura spots. After the WATCHMAN, I took Plavix for six months and had many occurrences of purpura.

Many people in their 80s have your exact issue, called “solar purpura.” The skin on the top of the hands, wrists and arms gets damaged by decades of sun exposure and can easily bruise. The Plavix you took is long gone and can’t be causing problems now, and it doesn’t cause permanent damage either. So, I agree with your cardiologist, but I do wonder if you are taking aspirin, which also affects platelets and would increase the risk of these superficial bruises.

However, this doesn’t necessarily translate into the main goal, which is the prevention of fracture. When looking at all studies, people in nursing homes received a benefit with combined calcium and vitamin D, while people who lived in the community did not have a reduced risk of fracture. Nearly all of these studies have been done on women only.

It’s also critical to remember that in studies using bisphosphonate drugs, like alendronate, all patients received supplemental calcium and vitamin D. These studies showed reduced fracture rates. To follow evidence-based medicine, we recommend our patients get adequate calcium and vitamin D.

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