I've Been Taken Off Aspirin

[tigerlily]

Hello everyone,
First off, let me say thanks to this site. It's a life saver. I'm wondering if any of you who have tissue valves have been taken off of aspirin? I am currently taking no medication for my tissue valve replacement. I was taken off when I developed an ulcer and was told I don't need to take aspirin anymore but this worries me. How has the thinking on this issue changed? Has anyone else had this experience? I thought that if you have a tissue valve replacement, you need to take a baby aspirin a day to prevent clots. My cardiologist had to cancel my annual appointment coming up in June and reschedule for several months out, so I won't have a chance to question him on this until Sept. Your thoughts and experience are appreciated.

 

[normofthenorth]

Tigerlily, I may be wrong, but I think most of the evidence for the health benefits of aspirin/ASA are from population studies, that found that people who took aspirin (for whatever reason) had lower rates of MIs and some other bad outcomes. I'm not aware of solid evidence from randomized trials, but I haven't searched and I'm no expert. Recently, I read a summary of the evidence pro and con administering low-dose aspirin/ASA to everybody, or all males over 50, and the evidence of benefit seemed underwhelming to me.

Me, I just finished a couple of weeks without my nightly 81 mgs of aspirin/ASA, since reading that it's one of the drugs that can cause or exacerbate tinnitus -- which I've had for the past year, roughly. The tinnitus may have improved since, though I've since had one scary brief bout of vertigo -- most likely unrelated, though ya' never know. . .

If anybody has seen solid evidence on aspirin/ASA, I'm certainly curious.

 

[kfay]

I tried to take aspirin for a couple of the months immediately after my valve replacement, but I have a sensitivity/allergy to it, so wasn't able to. I was very worried about it at first, but my surgeon and cardio at the Mayo clinic assured me that it was okay for me to not take it. They told me that it wasn't a common practice world wide to put tissue valve patients on aspirin and that it wouldn't effect the life of the valve. I am now on year 4 without taking it and have not had any issues so far.

Kim

 

[RobThatsMe]

Where you under your cardiologists orders intially to take the aspirin?
If so, was it him that advised you to stop taking it, or another doctor?

If it was another doctor, I personnally would have consulted with my cardiologist prior to stopping the dose.
Have you tried the coated aspirin, Ecotrin? This is supposed to help with any stomach issues.

Rob

 

[epstns]

I remember the same data that Norm does -- that daily doses of aspirin were associated with lower incidence of heart attacks. The data had nothing to do with valves. So, if you are not in any of the high risk groups for heart attack, you can probably drop the aspirin with little to no risk.

Norm - I can also attest to the fact that prolonged high dosages of aspirin can cause tinnitus. I took large doses of aspirin some years ago for an inflammation of a nerve, and after a few days I couldn't get rid of the ringing. (Once I answered the phone - just got the dial tone.) Shortly after I stopped the aspirin, the noise went away. At least the tone is better than the voices. . .

 

[Rachel]

I'm curious about this too, I also have a tissue valve and my cardiologist told me that after 6 months I'd be able to go off aspirin, but at my 6 month check-up my surgeon told me to stay on it (but he didn't say for how much longer).

How long were you on aspirin after surgery?

 

[ottagal]

You may be interested in reading this thread. I had the exact same question a while ago and posted a similiar question. I was confused as one cardiologist suggested I stay on the 81 mg of ASA and another cardiologist said I didn't need to.
http://www.valvereplacement.org/for...tic-Tissue-Valvers-and-Aspirin-Use&highlight=

 

[ElectLive]

Long term use of low dose aspirin in patients with bioprosthetic valves is a Class I - Level of Evidence C recommendation of the ACC/AHA valve disease guidelines here in the US.

Basically, that's the strongest recommendation level possible but with only the weakest level of evidence. There is a "Treatment Certainty" system that all evidence and recommendations such as these are classified under. A Class I recommendation specifically means the treatment is beneficial and effective and should be done. But a Level of Evidence C specifically means that only very limited population risk strata have been evaluated. This doesn't mean the evidence is weak necessarily just not thoroughly studied in randomized clinical trials. So basically only consensus of expert opinion and case study evidence. Some things just don't lend themselves to randomized trials, also. For instance, there's probably not much motivation (such as a competing drug company) to prove aspirin is unnecessary.

In any case, guidelines are guidelines and patients are patients, they don't often align. There's a guideline standard INR range for different types of mechanical valves, but for those with bleeding problems, the range is often lowered, and for those with stroke problems, the range is often raised. This seems to be a somewhat similar circumstance, and it's good to learm more from others already doing so.

 

[ottagal]

Long term use of low dose aspirin in patients with bioprosthetic valves is a Class I - Level of Evidence C recommendation of the ACC/AHA valve disease guidelines here in the US.

Basically, that's the strongest recommendation level possible but with only the weakest level of evidence. There is a "Treatment Certainty" system that all evidence and recommendations such as these are classified under. A Class I recommendation specifically means the treatment is beneficial and effective and should be done. But a Level of Evidence C specifically means that only very limited population risk strata have been evaluated. This doesn't mean the evidence is weak necessarily just not thoroughly studied in randomized clinical trials. So basically only consensus of expert opinion and case study evidence. Some things just don't lend themselves to randomized trials, also. For instance, there's probably not much motivation (such as a competing drug company) to prove aspirin is unnecessary.

In any case, guidelines are guidelines and patients are patients, they don't often align. There's a guideline standard INR range for different types of mechanical valves, but for those with bleeding problems, the range is often lowered, and for those with stroke problems, the range is often raised. This seems to be a somewhat similar circumstance, and it's good to learm more from others already doing so.

Elective,
Thank you for a most informative response! I must have missed the ACC guidelines on this. It now makes sense why one doctor may recommend aspirin and another not. I guess it all depends on the cardio's 'interpretation' of the guidelines and the patient's history.

 

[neil]

good reading ,

 

[ElectLive]

I was very worried about it at first, but my surgeon and cardio at the Mayo clinic assured me that it was okay for me to not take it. They told me that it wasn't a common practice world wide to put tissue valve patients on aspirin...

According to the Guidelines on the Management of Valvular Heart Disease (http://www.escardio.org/guidelines-surveys/esc-guidelines/GuidelinesDocuments/guidelines-VHD-FT.pdf) of The European Society of Cardiology: "Finally, there is no evidence to support the long-term use of antiplatelet agents in patients with bioprosthesis who do not have an indication other than the presence of the bioprosthesis itself."

Interestingly, there are other differences as well (in comparison to the US guidelines). Antiplatelets aren't automatically recommended to supplement anticoagulation for those with mechanical valves. Instead, only for those with indications such as concomitant arterial disease. Also, there is much firmer recommendation for the first 3 months to anticoagulate those with a tissue valve (target INR 2.5) with the following comment: "However, there is widespread use of aspirin (low dose: 75–100 mg) as an alternative to anticoagulation for the first 3 months, but there are no randomized studies to support the safety of this strategy".

 

[enkaynj]

My cardio said no need but doesn't hurt to take a baby aspirin unless of course you have undesirable side effects.IMO, there is no need to take any medication just because you got a tissue valve.

 

[hansong]

tigerlily,

I did the aspirin routine for a couple of months after my valve replacement, but have dispensed with it for the past two years. I don't take any medications either (other than a theraputic glass of wine or two). The government requires me to get an echo, ECG and MRI every year in order to keep my job and so far the valve and the rest of my heart is doing very well. Who knows how long the status quo will last, but I plan to keep my hand in play as long as possible.

Good luck and good health to you.

 

[malibu82]

i have a bovine valve and was on the prescription dose of aspirin after surgery for 3 months(325mg?), then told to switch to a baby/81mg aspirin daily. they said it is to prevent clots on the valve.......

so i have been taking it religiously. some days i do go 36 or 48 hours without one if i forget.....no problems yet. but the only reason i was told i was taking it was to prevent clots, not for any other reason....

 

[normofthenorth]

I remember the same data that Norm does -- that daily doses of aspirin were associated with lower incidence of heart attacks. The data had nothing to do with valves. So, if you are not in any of the high risk groups for heart attack, you can probably drop the aspirin with little to no risk.

Norm - I can also attest to the fact that prolonged high dosages of aspirin can cause tinnitus. I took large doses of aspirin some years ago for an inflammation of a nerve, and after a few days I couldn't get rid of the ringing. (Once I answered the phone - just got the dial tone.) Shortly after I stopped the aspirin, the noise went away. At least the tone is better than the voices. . .

Thanks for the LOL(s), Steve! I went without LDA for about a month and didn't notice much difference in the tinnitus, so I've started again, despite the weak evidence. Who knows?