On-x valve, what medications are you on post surgery?

[GreenGiant91]

Hey all,

I had an appointment with the surgeon and was told I would be on the low dose aspirin for life as well as warfarin, my understanding was the aspirin was a short term medication for 3 months. Their justification for this is they view it as a safety net.

I’m in a bunch of other meds for the heart too. But curious is anyone else told they’re on warfarin and aspirin for life?

 

[pellicle]

hey
if you've got a mechanical valve you're going to be on warfarin as long as you've got the mechanical valve. Basically its not bad.

I'm also taking aspirin but perhaps lower dose than usual. There are good reasons to be on it but perhaps not what you may think. Did you see the post I made on aspirin in the off topic forum?

Warfarin management is so easy even I can do it.

https://cjeastwd.blogspot.com/2014/09/managing-my-inr.html
HTH

 

[GreenGiant91]

hey
if you've got a mechanical valve you're going to be on warfarin as long as you've got the mechanical valve. Basically its not bad.

I'm also taking aspirin but perhaps lower dose than usual. There are good reasons to be on it but perhaps not what you may think. Did you see the post I made on aspirin in the off topic forum?

Warfarin management is so easy even I can do it.

https://cjeastwd.blogspot.com/2014/09/managing-my-inr.html
HTH

Yeah I knew about the warfarin being for life. It was more the aspirin for life wasn’t something that was made clear to me before the surgery.

 

[Timmay]

A friend sent me this video. If you’re worried about the safety of aspirin, watch the first 30 min or so if this video. It’s safer than people think.

 

[Dunwanted]

Hello GreenGiant,

i had my surgery on november 2022, on x valve.

Since my surgery i have been on warfarin and aspririn which i was told i have to take for my entire life, i am also taking metropolol daily (my doses have changed here and there) but i guess this last one depends on each person how their heart rate is after surgery.

warm regards,

 

[Lynn]

I have an On-x valve and am allergic to ASA, so I can’t take aspirin. According to my surgeon , the studies on the safety of INR for on-x valves all included aspirin. What these means for me, is my INR target is higher at 2.5. I suppose you could say, A higher INR is my safety net. I knew this prior to valve surgery.

With respect to other meds like beta blockers, they are often prescribed after surgery. The need to stay on them long-term should depend upon your health issues. I am not on any other hearts meds, just warfarin and haven’t been on any since my surgery. Reviewing meds with your cardio to see If they are still need probably makes sense as you move forward.

Best of luck.

 

[Chuck C]

I have an On-x valve and am allergic to ASA, so I can’t take aspirin. According to my surgeon , the studies on the safety of INR for on-x valves all included aspirin. What these means for me, is my INR target is higher at 2.5

Your surgeon is correct. The PROACT Trial included low dose aspirin. Good for him for being aware of this. Some who have given their patients On-x valves and have them on the low 1.5 to 2.0 miss this important detail. I believe it is wise to have you target 2.5 in this circumstance.

 

[Chuck C]

A friend sent me this video. If you’re worried about the safety of aspirin, watch the first 30 min or so if this video. It’s safer than people think.

That presentation is well worth the listen. Thanks @Timmay and thanks to your friend who sent it to you. Can't imagine who that could be

 

[Lynn]

Your surgeon is correct. The PROACT Trial included low dose aspirin. Good for him for being aware of this. Some who have given their patients On-x valves and have them on the low 1.5 to 2.0 miss this important detail. I believe it is wise to have you target 2.5 in this circumstance

When making the decision between mechanical and tissue, the aspirin allergy added an additional complexity. It factored into the decision making and was an issue with either valve type. In discussions with my surgeon and cardio, they both said they also recommended an aspirin for patients post tissue valve.. As a safety net, or preventative med. As for me, that was out of the question, I could end up on another med like plavex in loo of aspirin. So I could have gone tissue to avoid warfarin and ended up on a med anyway. That was my cardio’s concern. Having taken Plavex before, I can say I prefer warfarin. Plavex gave me an annoying cough.

 

[tom in MO]

Hey all,

I had an appointment with the surgeon and was told I would be on the low dose aspirin for life as well as warfarin, my understanding was the aspirin was a short term medication for 3 months. Their justification for this is they view it as a safety net.

I’m in a bunch of other meds for the heart too. But curious is anyone else told they’re on warfarin and aspirin for life?

Yes...me. My first and second cardiologists said the same thing.

 

[vitdoc]

As far as I am aware the routine use of aspirin after mechanical valve surgery is not universally suggested. If one wants to run a very low INR as suggested by On-X than aspirin should be added to comply with what was done in On-X's trial. As many have mentioned if stroke is a high priority to avoid than running a low INR may not be advisable especially since the INR may dip below 1.5. But, if someone wants to go that route aspirin would be recommended. Otherwise with more standard INR say 2.5+ there is no consensus that aspirin is mandatory. Personally I don't take aspirin with warfarin since it seems to materially lengthen the clotting time than warfarin alone.

 

[carolinemc]

As far as I am aware the routine use of aspirin after mechanical valve surgery is not universally suggested. If one wants to run a very low INR as suggested by On-X than aspirin should be added to comply with what was done in On-X's trial. As many have mentioned if stroke is a high priority to avoid than running a low INR may not be advisable especially since the INR may dip below 1.5. But, if someone wants to go that route aspirin would be recommended. Otherwise with more standard INR say 2.5+ there is no consensus that aspirin is mandatory. Personally I don't take aspirin with warfarin since it seems to materially lengthen the clotting time than warfarin alone.

If you had a blot clot, they would have you take an 80mg Aspirin. St. Jude's Valve in 2001.

 

[3mm]

is anyone else told they’re on warfarin and aspirin for life?

My cardiologist suggested taking aspirin as extra protection beyond the warfarin, as long as I tolerate the aspirin well. If we ever think the aspirin is a problem, then we will stop prescribing it. She has read the various studies, and she feels aspirin gives some additional protection against stroke while having minimal negative impact on me.

 

[pellicle]

Morning

as long as I tolerate the aspirin well

here's some tips on that for those with potential stomach issues

• don't ever just "take your pills", its not tough or rugged its just stupid .. its always better to have your medications with something, and a meal is perfect. If you can't conveniently time this, then use a glass of milk or even a spoonful of yoghurt
• its amazing to me that still so many don't know that Heliobacter is responsible for almost all cases of stomach bleeds and is easily diagnosed and treated
• there is no difference between expensive aspirin and the cheapest variety.
• lower doses are quite effective, for instance there is little difference between 100mg and splitting a 150mg pill into 75 and taking that

being BAV and having had an aneurysm the principle benefit I seek isn't ischemic event prevention its platelet interference. The half life of aspirin is quite short (about 20 min in the blood plasma) so while the drug is gone quickly the effect remains because the platelets have a longer life (10 days)

from:
https://www.ahajournals.org/doi/10.1161/01.cir.101.10.1206

Aspirin is rapidly absorbed in the upper gastrointestinal (GI) tract and results in a measurable inhibition of platelet function within 60 minutes​

but that's not the entire picture

The plasma half-life of aspirin is only 20 minutes; however, because platelets cannot generate new COX, the effects of aspirin last for the duration of the life of the platelet (≈10 days). After a single dose of aspirin, platelet COX activity recovers by ≈10% per day as a function of platelet turnover​

from:
https://pubmed.ncbi.nlm.nih.gov/10390126/

Prostaglandins are formed from arachidonic acid by the action of cyclooxygenase (COX) and subsequent downstream synthetases. Recently, it has been found that there are two closely related forms of COX, which are now known as COX-1 and COX-2. ... COX-1, the predominantly constitutive form of the enzyme, is expressed throughout the body and provides certain homeostatic functions, such as maintaining normal gastric mucosa, influencing renal blood flow, and aiding in blood clotting by abetting platelet aggregation. In contrast, COX-2, the inducible form, is expressed in response to inflammatory and other physiologic stimuli and growth factors and is involved in the production of those prostaglandins that mediate pain and support the inflammatory process​

Best Wishes