Dear Dr. Roach: I take Eliquis. I have no stomach; it was totally removed as a preventative measure due to the risk of stomach cancer. So, I have been trying to find out how much of this expensive drug is actually being absorbed. So far, my cardiologist, my primary care physician, nor my pharmacist can answer this question. I sent an email to the manufacturer of Eliquis, but received no response.
Am I wasting my money on this expensive drug? Would chewable baby aspirin work as well or better? Is there a blood test I should take? (Again, I received several conflicting answers on this.) I feel like I may not be reaping the benefits of Eliquis.
A.S.
Eliquis is an anticoagulant usually used in people with a history of or at a high risk for blood clots. It works by inhibiting the activated form of clotting factor X, a critical protein needed to make blood clots. Aspirin is not a safe replacement, as it works in a different way.
Very few drugs are substantially absorbed by the stomach. Eliquis is mostly absorbed in the first part of the small intestine, although a small amount of it is absorbed in the stomach. It is very likely that the vast majority (if not all) of the Eliquis is still being absorbed by the intestine after your stomach surgery, and most people get beneficial effects at the usual dose without the danger of excess bleeding.
However, there is a commercially available blood test to check whether Eliquis (or a similar drug) is at the correct dose. The test checks the amount of activated factor X, and there are published data about the expected level of this clotting factor while on treatment. So, if precise dosing were truly critical, your doctor can check your blood level and adjust your dose if needed.
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 [email protected] or send mail to 628 Virginia Dr., Orlando, FL 32803.
