Question for Aortic Tissue Valvers and Aspirin Use

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ottagal

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Hi Everyone,

After my AVR with a bovine tissue valve, I was put on 325 mg. of aspirin for the first 3 months post-op. I was told I could discontinue after that time period. I did not experience a-fib post op (and hopefully it will stay that way!! ) and have no history of coronary artery disease (just dealing with tachycardia right now :)).

For those with AVR and no history of coronary artery disease, I am curious to know what others have been advised with regards to aspirin use post-op AVR (with tissue valve), the amount they are taking and if/when it is suggested they discontinue.

Are there any benefits to long term use of aspirin as a prophylactic measure with a tissue valve?

From the various posts I have read, it appears that it is different for everyone.
 
Tissue valve here and I was prescribed 81mg (baby) aspirin daily.
At surgery I had (and hopefully still have) clear and my original arteries.
John
 
I was on the 325 for one full year (a mistake, I think they forgot to tell me to stop), then went down to 81 mg. forever,and I have a tissue valve......
 
Interesting thread! I'm 62 with coronary arteries clear at time of AVR (porcine) 2 yrs ago. According to my cardiologist, I'm on 325 mg aspirin daily for life. She would agree to halving it if GI doc thinks it would help relieve GERD--still waiting for an answer from him. My primary care doc speculates it's because of slight carotid deposits (but could that be because of the Vytorin I took because it "might" help delay valve decline?). Because I have lots of allergy headaches and my aging knees hurt, I'm not protesting too much....
 
The three month course of aspirin is in lieu of the coumadin that was often prescribed after tissue valve surgery (still is, in some cases). Three months is the amount of time it takes to be sure the cut areas have all regrown their endothelium, a protective, internal skin. Until that regrowth is complete, there is a greater risk of stroke, as well as infective endocarditis. The aspirin is to counter that stroke risk. Plavix is often prescribed with it.

Assuming no AFib or other special, specific need for the aspirin, it has the same potential benefits as an 81mg aspirin does for any otherwise basically healthy person over fifty, regardless of heart operations. It can reduce the likelihood of clotting, strokes, or heart attack in some people.

Best wishes,
 
Let's hear it for the cows, our bovine friends! After the AVR, my Surgeon put me on Metoprolol and one 325mg Aspirin a day so he must be using the same info as your's, Ottawa & Debby. He said that by the end of the first year after surgery I could stop taking the Metoprolol but that I should plan on taking the Aspirin for life. The effect of aspirin is of course to prevent blood platelets from clumping together to form clots. He told me that 30 minutes after taking an aspirin its antiplatelet function is at work and it doesn't stop until several days after one stops taking a daily dose so forgetting to take one's aspirin for a day should be no big deal. He said that with the implant of any foreign object, even a tissue valve, in the heart there is a slight risk of developing clots around the implant and that the aspirin is just to minimize that slight risk. He went on to add that, initially, the risk of clotting although still small is, perhaps, a little higher just after surgery. Later, as years pass and the surface of the tissue valve becomes less smooth the risk can rise again so the recommendation is to continue taking the aspirin unless there is some other reason to stop doing so. Aspirin is the preferred choice because it is effective, widely available and very inexpensive. Some surgeons consider the risk of clotting with a tissue valve small enough that they don't recommend aspirin so I guess my guy is one of the more conservative ones. Then of course there is the other aspect of aspirin therapy to help prevent arterial clotting. I, for one, have been taking a low dose aspirin for the past decade at my Doctor's direction because I have an extensive family history of arterial disease and I'm over 50. One unanticipated benefit of preparing for the AVR was learning during the two heart caths done last year that it didn't appear I have any arterial disease but even so the threat is still there. For most of, then, one aspirin of whatever size is not a very bitter pill to swallow.

Larry
 
I notice that No One mentioned taking Enteric (coated) Aspirin which does not disolve until it has passed from the stomach into the intestines.
.
Some (conservative) Gastroenterologists like to recommend that patients taking aspirin also take Carafate (or it's Generic equivalent) which coats the stomach to help heal (and prevent) ulcers from forming, especially if you are taking (presumably uncoated) Aspirin.

'AL Capshaw'
 
My story is identical to Larry's. Family history of heart attacks I have arterial disease though, with 1 stent and 1 CABG done during AVR to avoid future operations as the artery was only 40% occluded. Have been taking 81 mg enteric coated aspirin for more than 10 years and will continue for rest of life.. being an anti-inflamatory it also helps with the old joints..
 
Thank you everyone for your great informative responses!! It appears that I am in the minority with regards to complete discontinuation of aspirin (thank you Al for mentioning the enteric coated version and I was on that one).

I wonder if the reason I have been taken off the aspirin is because I am female and under 50 years of age. There is some history of CAD in my family, but according to the docs. it does not place me in a really high risk category because of the age of onset was 60 and over.

I googled aspirin use and bioprosthetic valves, but only came up with results on the use of aspirin post-op for the first 3 months, nothing long term.

I do recall seeing a study that the benefits of aspirin re: CAD and stroke were different for both genders. I will have to see if I can dig up that study.

Hmmmm.....So, now I have to ask myself, should I continue taking enteric coated aspirin (81 mg) on my own to err on the safe side although I have been told to discontinue? Or does it really have any preventive benefits in my case (such as mentioned by Mentu's surgeon, who appears to be more conservative than mine).
What do you think VR gang?
 
Found the Article on Aspirin Use and Gender Difference for Prevention of CAD

Found the Article on Aspirin Use and Gender Difference for Prevention of CAD

Hi Folks,

I just found this updated article from the Annals of Internal Medicine: So, it looks like it isn't recommended in my age category for the prevention of CAD; however, still wondering if aspirin would be of any benefit from a valve perspective?

http://www.annals.org/content/150/6/396.full
Clinical Guidelines
Aspirin for the Prevention of Cardiovascular Disease: U.S. Preventive Services Task Force Recommendation Statement

From the U.S. Preventive Services Task Force, Agency for Healthcare Research and Quality, Rockville, Maryland.
Next SectionAbstract
Description: Update of the 2002 U.S. Preventive Services Task Force (USPSTF) recommendation about the use of aspirin for the prevention of coronary heart disease.

Methods: Review of the literature since 2002, focusing on new evidence on the benefits and harms of aspirin for the primary prevention of cardiovascular disease, including myocardial infarction and stroke. The new evidence was reviewed and synthesized according to sex.

Recommendations: Encourage men age 45 to 79 years to use aspirin when the potential benefit of a reduction in myocardial infarctions outweighs the potential harm of an increase in gastrointestinal hemorrhage. (A recommendation)

Encourage women age 55 to 79 years to use aspirin when the potential benefit of a reduction in ischemic strokes outweighs the potential harm of an increase in gastrointestinal hemorrhage. (A recommendation)

Evidence is insufficient to assess the balance of benefits and harms of aspirin for cardiovascular disease prevention in men and women 80 years or older. (I statement)

Do not encourage aspirin use for cardiovascular disease prevention in women younger than 55 years and in men younger than 45 years. (D recommendation)

The U.S. Preventive Services Task Force (USPSTF) makes recommendations about preventive care services for patients without recognized signs or symptoms of the target condition.
 
Well, there you have it Ottowagal. That covers it. It was suggested that I take aspirin because of my age (54) and gender, not because of anything related to a cardiovascular condition or my valve replacement, during my physical last year. I had not been taking it after my surgery.
 
I am on 81mg too. I started on 325mg. when I came home from the hospital and shortly there after changed to 81mg. It is hard on my stomach (yep, they are coated) so doc told me to take them every other day.
 
I have been on 325mg Enteric Aspirin since surgery and it's now just about 6 months. Not sure if cardio will keep me on 325 or drop me to 81. Will be going in next month for check-up.
 
My Father was on Coudamin for 6 months post-AVR (CE Bovine Perimount) due to suspected Atrial Clot, but has now reverted to 100mg Aspirin once a day for life. We are told this is precautionary for tissue valvers.

Kind regards

Simon
 
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