Daily Aspirin Post Aortic Valve Replacement

[Seaton]

I currently take a daily 75mg dispersible aspirin (in water) following a capsule of omeprazole (to aid the stomach for the aspirin ingestion). The aspirin is now a permanent med for me post AVR, as prescribed by my surgeon.

I’ve been on the omeprazole for some weeks now and I feel it is upsetting my stomach. Stomach upset is one of its side effects. Other side effects of omeprazole, especially on long term use, don’t look that attractive.

I skipped my omeprazole this morning to see if my stomach settles and just took the aspirin. I spoke with my GP later and she suggested I switch to lansoprazole for a month or so and see how I do with that. Lansoprazole is in the same ball park as omeprazole in terms of side effects pretty much.

I’d rather not be taking one of these proton pump inhibitors with my aspirin. But the consensus seems to be it aids the safe ingestion of aspirin by reducing the risks of internal bleeds from prolonged aspirin prescription.

My questions:

Are others here with bioprosthetic valves on daily aspirin combined with any of these stomach protective meds?​

If so, have you experienced any side effects as the weeks pass?​

Or are you taking aspirin alone?​

If just taking aspirin (long term), have you experienced any physical issues ... bleeds etc.?​

Or is everything hunky dory?​

​

Thanks in advance!

 

[LoveMyBraveHeart]

Mathias had been on 2, 81mg n(162mg total) aspirin after his bioprosthetic valve was placed, no anti-acids or stomach coating medications went with it. He never experienced GI upset from it. He has been reduced to one 81mg tablet since his on-x implant in August.

This may be an odd suggestion and I hope it doesn't come off as offensive, but in animal medicine when, say, a dog ingests an NSAID we use sucralfate to treat/inhibit stomach ulcers. In it's same drug family is famotidine, which comes in 10mg and 20mg doses. I have taken both, and they are pretty gentle on the tummy as far as I could tell (I'm awfully sensitive to meds). Sucralfate is Rx only, but you can buy famotidine OTC. Granted, its a histamine-2 blocker, not a proton pump inhibitor so I'm unsure if it would work in your case or not, but might be worth asking about?

I know a medication that really got to Mathias' stomach was colchicine. If you are on this, I would also look at that as the possible source of your GI upset...its very common with this med.

Best of luck, hopefully you can find something that works better for you.

 

[Seaton]

Thank you @LoveMyBraveHeart
Not offensive at all A fascinating suggestion. It’s great to hear what others have experienced and how they approach such things. I’m just over 9 weeks since AVR and learning something new every day!
Best to you.

 

[Keithl]

Why not use an enteric coated aspirin that does not upset the stomach much, also think about taking the aspirin with some food that may offset the aspirin impact.

 

[ForeverThankful]

For 4 years I've been taking an 81mg aspirin every day. After about the first 6 months it started to bother my stomach so I switched to enteric coated aspirin and I no longer have any problems. I also take it with dinner.

 

[Agian]

Other than the young girl comparing Seaton to a hound, everything is indeed hunky dory.

I take aspirin and esomeprazole (nexium). There's a few in this family and you may have to try various ones until you find one that suits you. I did.

 

[LoveMyBraveHeart]

Other than the young girl comparing Seaton to a hound, everything is indeed hunky dory.

I take aspirin and esomeprazole (nexium). There's a few in this family and you may have to try various ones until you find one that suits you. I did.

Aw, that was the exact opposite of what I was trying to do! However, I like dogs more than people, so I would take it as a compliment..

 

[Brokenhip]

Taking one non coated mini aspirin (100 mg here in Aus.) per day, with breakfast for the past 20 months. No adverse effects. Probably should change to the coated model (my wife does) to insure less chance of problems.

 

[Paleowoman]

Hi @Seaton - sorry to hear they are prescribing you Omeprazole long term. I'm sure I have read recently that this, and other Proton Pump Inhibitors, are being advised to be prescribed only short term as long term they have many side effects. They interfere with vitamin B12 production, interfer with calcium and other mineral absorbtion (the problem with calcim absorbtion can lead to osteoporosis), also the PPI can lead to lower gastrointestinal problems due to incomplete digestion and due to overgrowth of bacteria in the small bowel and more - this is because the Proton Pump Inhibitor stops the production of stomach acid. We do need our stomach acid, it's not there by mistake, it is vital for our digestion in the stomach.

An enteric coated low dose aspirin would be much better, or better still no aspirin and some other alternative.

What is the reason for the permanent aspirin ?

As you know, I have a bioprosthetic valve, but I have never been prescribed aspirin post surgery. The reason I know about Proton Pump Inhibitors is that I was prescribed them a few years ago because of another med I was being prescribed and looked into them and looked into why we need stomach acid - I refused to take them.

I can see you are in a difficult situation

 

[Protimenow]

Is there a reason that you're taking what you call a 'dispersable' aspirin instead of a pill?

Personally, I use an 81 mg, enteric coated aspirin each night. The coating keeps the aspirin from dissolving in my stomach. I have not had any issues with stomach problems and probably won't. Here in the United States, these things cost about 1 cent each - very inexpensive.

I take this with other meds that I take once a day - none of them antacid or proton pump inhibitors - and even a combination of other meds with this low dose aspirin haven't caused stomach irritation.

But, again, I'm wondering if there's a reason why you're taking this 'dispersable' aspirin.

 

[Agian]

I'm taking the ppi because of reflux, not because I'm on aspirin.

 

[Suckyvalvegurl]

I only had to take the aspirin for 3 months after my AVR. Is there some reason they feel you need it?

 

[Seaton]

Why not use an enteric coated aspirin that does not upset the stomach much, also think about taking the aspirin with some food that may offset the aspirin impact.

Hi @Keithl
I hadn’t considered the enteric coated aspirin. I went with what was offered by my ‘team’.

I’ve just been reading up about enteric coated tabs. There seems to be some debate about whether the enteric is any more effective on the stomach than dispersible. Some research even suggests it’s less effective in inhibiting clotting. But the jury’s still out, it seems.

I’ve always taken my dissolved aspirin first thing in the morning with my breakfast. I’m on my second day of self-stopping the PPI I was prescribed – omeprazole. I’ve been given a new prescription for Lansoprazole as an alternative. But before I start taking that, I want to see how I react to just taking the aspirin first and see if things settle down. I certainly feel a bit better stomach wise already today. So let’s see.

Thanks for your comment.

 

[Seaton]

For 4 years I've been taking an 81mg aspirin every day. After about the first 6 months it started to bother my stomach so I switched to enteric coated aspirin and I no longer have any problems. I also take it with dinner.

Thanks @ForeverThankful.
Good to hear you’ve been taking just the aspirin long term without anything too untoward happening - the stomach upset after six months, notwithstanding. Interesting you then switched to enteric and things settled down. Think I’ll try the dispersible aspirin alone for a while and see what happens ... hopefully nothing!

 

[Seaton]

Hi @Seaton - sorry to hear they are prescribing you Omeprazole long term. I'm sure I have read recently that this, and other Proton Pump Inhibitors, are being advised to be prescribed only short term as long term they have many side effects. They interfere with vitamin B12 production, interfer with calcium and other mineral absorbtion (the problem with calcim absorbtion can lead to osteoporosis), also the PPI can lead to lower gastrointestinal problems due to incomplete digestion and due to overgrowth of bacteria in the small bowel and more - this is because the Proton Pump Inhibitor stops the production of stomach acid. We do need our stomach acid, it's not there by mistake, it is vital for our digestion in the stomach.

An enteric coated low dose aspirin would be much better, or better still no aspirin and some other alternative.

What is the reason for the permanent aspirin ?

As you know, I have a bioprosthetic valve, but I have never been prescribed aspirin post surgery. The reason I know about Proton Pump Inhibitors is that I was prescribed them a few years ago because of another med I was being prescribed and looked into them and looked into why we need stomach acid - I refused to take them.

I can see you are in a difficult situation

Hi Anne!

Not sure why the aspirin’s been prescribed long term. It’s what the surgery team advised at my 6 week check-up. I’ll speak with my GP again and maybe my cardiac nurse and ask if long term is inevitable.

My cardiology check-up isn’t until next year, so could discuss with the cardiologist then, too.

Interesting you’ve never been prescribed them. I wonder why?

 

[Seaton]

I'm taking the ppi because of reflux, not because I'm on aspirin.

Greetings @Agian
Any side effects from the esomeprazole?

 

[Seaton]

I only had to take the aspirin for 3 months after my AVR. Is there some reason they feel you need it?

Hi @Suckyvalvegurl

I imagined I’d only be on it short term ... say, three months or so, like you. But the surgeon said it was needed long term as a clot preventative. I‘ve not had to take any other meds post surgery (other than the omeprazole) so was feeling quite lucky it was just aspirin. I’ll query it further. Thanks for the reply!

 

[Seaton]

Is there a reason that you're taking what you call a 'dispersable' aspirin instead of a pill?

Personally, I use an 81 mg, enteric coated aspirin each night. The coating keeps the aspirin from dissolving in my stomach. I have not had any issues with stomach problems and probably won't. Here in the United States, these things cost about 1 cent each - very inexpensive.

I take this with other meds that I take once a day - none of them antacid or proton pump inhibitors - and even a combination of other meds with this low dose aspirin haven't caused stomach irritation.

But, again, I'm wondering if there's a reason why you're taking this 'dispersable' aspirin.

Hi @Protimenow

Good to hear the enteric isn’t causing any issues long term. I may eventually switch to that.

I’m imagining the ‘dispersible’ (it’s how it’s spelt on the box here ) aspirin is absorbed quicker, but I can’t be sure of that. Having said that, I’ve just read this:

​

https://newsnetwork.mayoclinic.org/...-be-as-effective-at-reducing-blood-clot-risk/​

It says:

“...However, with enteric-coated aspirin, research indicates that bloodstream absorption may be delayed and reduced, compared to regular aspirin absorption. Regular aspirin is quickly dissolved and absorbed in the stomach. As a result, enteric-coated aspirin may not be as effective as regular aspirin at reducing blood clot risk.​

​

But then again there is this link:

https://www.health.harvard.edu/heart-health/aspirin-advice-coated-vs-plain​

​

Which says, re enteric:

“...However, because the drug's anti-clotting effect lasts for more than just one day, slight variations in day-to-day absorption might not matter all that much, assuming a pill is taken every single day.”​

​

Interesting stuff.

 

[Paleowoman]

Hi Anne!

Not sure why the aspirin’s been prescribed long term. It’s what the surgery team advised at my 6 week check-up. I’ll speak with my GP again and maybe my cardiac nurse and ask if long term is inevitable.

My cardiology check-up isn’t until next year, so could discuss with the cardiologist then, too.

Interesting you’ve never been prescribed them. I wonder why?

Hi Seaton - I've no idea why I've never been prescribed aspirin....and you don't know why you have been prescribed it ! Very strange. And strange that some people have it long term and others never. Might be just be due to some cardiac surgeons' protocol ?

 

[tom in MO]

I have a mechanical valve and take the cheapest 80mg aspirin every day before dinner with no trouble. I think this is protocol for mechanical valves. For tissue, I think I've seen others that say they took it for awhile after surgery, with warfarin, but stopped both after a few months.