Anti-coagulants after (Aortic) heart valve replacement surgery?

[DinoCat]

Just comparing experiences re anti-coagulants with others who have had (Aortic) heart valve replacement surgery. For those with a ‘mechanical’ replacement valve, it’s straightforward – i.e., a standard requirement to go on Warfarin (or equivalent?) for life.

However, for those who opted for a ‘biological’ replacement valve (specifically, in my case, an Edwards Inspiris Resilia), what were you advised re post-surgery anti-coagulants? My (highly experienced) consultant surgeon was very clear that I could take one of the more modern anti-coagulants (Apixaban for me), but that this was only necessary for 3 months post-surgery. If after 3 months, renewed heart rhythm evaluation confirms a continuing stable ‘sinus rhythm’ (e.g., no atrial fibrillation), anti-coagulants could be discontinued.

I’d be interested in others’ experiences? This is especially as my cardiologist seems a little nervous about the discontinuation of anti-coagulants. He has raised whether I should instead now go onto anti-platelets meds (e.g., Aspirin), although he can’t seem to provide any evidence to back up this suggestion!

[Hidden]

Hi, My experience was very straightforward with a Tissue Aortic Valve, although it was a 1994 model rather than one of the new types of biological valves.

I had the valve for 19 years, and in that time the only medication I was on, was Aspirin, even that was taken on/off over the years. There was never any need for an Anti-Coagulant, but, as to whether thats still the common practice I dont know as I now have Mech valves.

Best wishes

[DinoCat in reply to Hidden]

Many thanks

[Rhinos67]

Hi DinoCatI had a mechanical valve and am on Warfarin and Aspirin.

I'm in a Facebook group.. UK Aortic and Heart Defects Pre and Post surgery and know that several have had the same valve as you, so it may be worth joining to ask their experiences

Joanne

[DinoCat in reply to Rhinos67]

Many Thanks

[francesw47]

Hi I have an Edwards valve (and had one of the older types of tissue valves prior to the Edwards) and only ever taken Aspirin. I was told, both times, that a tissue valve avoids the need to take Warfarin for life. At least thats how it was put to me. So aspirin was advised and I've taken now for 9 years or so. Of course in hospital I was given anticoagulants by injection daily but this was discontinued on discharge. It does seem to vary by hospital. What do the NICE guidelines say on the subject?

[DinoCat in reply to francesw47]

Many thanks. I did have a look via NICE some time back, but struggled to find anything. Perhaps I'll have another try!

[nursenancy53]

Hi, I have a tissue valve, no idea what sort, and have only taken aspirin since my op almost 5 years ago

[DinoCat in reply to nursenancy53]

Thank you. From replies so far it does seem that most people with Tissue replacement valves continue to take Aspirin, but don't need another ongoing anti-coagulant.

[Flowerfanatic]

Hi Dino Cat - I have the same replacement valve as you (May ‘21) and the only anticoagulant I am on is 75mg of aspirin (which I have been told will be for life). In hospital (Harefield) I was given daily injections which I presume were anticoagulants but the only drugs I left with were bisoprolol and ramipril and the aspirin.

All best wishes

Sarah

[DinoCat in reply to Flowerfanatic]

Thank you, Sarah. From replies so far it does seem that most people with Tissue replacement valves continue to take Aspirin, but don't need another ongoing anti-coagulant.

[WestCorkHeart]

After an Aortic Dissection and Aorta Valve replacement in August 2019 I was prescribed Aspirin. However after a mild stroke in Jan 2022 I was prescribed Clopidogrel (Plavix). After another stroke in April my anticoagulant was changed to Rivaroxoban (Xarelto) and this has continued after I contracted Endocartis in July 2022 and my Aorta Valve was re-replaced.

My Cardiologist thought that the Clopidogrel as prescribed by my Neurologist was not strong enough to clear the blood clots that had developed from my original operation.

[DinoCat in reply to WestCorkHeart]

Many thanks for the info. It sounds like you've had quite a few setbacks since 2022. I wish you well, especially since your latest Aortic valve replacement

[JHPW70]

Hi

I have the same valve as you and my surgeon and cardiologist took me off the one anticoagulant I was on at just short of three months post surgery. I now take nothing. I'm happy with this but remain puzzled as to why there is not a more consistent approach across patients.

John.

[DinoCat in reply to JHPW70]

Thanks - I agree with you! From the limited replies here to my query, it does seem that most with biological valves remain on Aspirin. But I can't find any medical evidence which backs this need up (inc via NICE), so I wonder if it's just an 'abundance of caution' by Cardiologists/Surgeons? Like you, I'm happy taking nothing (after the initial 3 months of anticoagulant). My Surgeon was pretty clear I needed nothing thereafter - it's just my Cardiologist who continues to raise the issue (maybe a bit of back-covering?)!