Coming off aspirin after AVR

[BicuspidBloke]

My cardiac consultant has signed me off aspirin and I'm wondering a) if it's typical and b) how best to do it.

I had AVR via OHS two years ago for a congenital bicuspid valve and chose the tissue valve. Before the operation the surgeon said I would be on aspirin for life. Now his consultant says my issue was purely down to the valve and now that is fixed I do not need a blood thinner. I understand that element but also have other issues like a still-enlarged LV. Rehab & recovery has been a dream with no problems (pre-diagnosis symptoms were minimal) and I'm back to running half marathons with my first marathon to come in London in April. The consultant is aiming to cease all medication for me (one-by-one) if my next Echo is good in Autumn (I'm also on Spironolactone, Entresto, Atorvastatin, Empagliflozin, Bisoprolol - all minimal levels). My worry is the medications, including aspirin, have all contributed to my recovery. So is anyone else NOT on a blood thinner at this stage?

And secondly, how best to do this? I have a week's supply of the aspirin left so do I stop suddenly or go alternate days or go down to half a tablet for a while. I didn't think to ask the consultant. I think I will keep one or two back in case I feel I need to return to them and can't wait for a prescription.

[Lowerfield_no_more]

If you stop your low dose aspirin its effect will die away over the next day or two. When I have needed to stop my aspirin for various procedures including dental work I stopped a day or two before and then started again a day or two after. There is, apparently, no 'withdrawal' effect.

[BicuspidBloke in reply to Lowerfield_no_more]

Good to know, thank you. A withdrawal effect was a concern. Cheers.

[Jedi14]

My aspirin was replaced in later stages, with clopidogril. The general thinking is that we hearties will remain on some form of blood thinners to prevent possible future strokes.

[BicuspidBloke in reply to Jedi14]

That is kind of my thinking. I'm going to get a second opinion because it seems a little odd to me. Thanks.

[DinoCat]

I too had a tissue valve AVR in Oct 2022 (bicuspid valve) & was on various heart-related meds for 3 to 4 months, inc a blood thinner (Apixaban). After reviews, I was told that all was in order & I could cease ALL meds (without weaning), which remains the case. Incidentally, that's one of the advantages of a tissue valve - if one has a mechanical valve they are more prone to clotting & it's Warfarin for life! My cardiologist was initially a bit nervous about not taking aspirin, but it seems this is because an extra-precautionary approach seems to be common (but not universal) amongst cardiologists in the UK. My consultant surgeon was adamant, however, that the benefits evidence base for taking aspirin with tissue valves is very slim, so we've followed his advice. Of course, there are some (small) risks with aspirin bleeds or stomach side-effects, so there need to be good contra-benefits from taking them long-term to outweigh those risks.

In my case I'm fortunate not to have any other underlying heart or circulatory issues & my blood pressure & cholesterol are reasonably under control. If that's not the case, the risk/benefits balance might be shifted for other patients in favour of aspirin, or a blood thinner.

[BicuspidBloke in reply to DinoCat]

Oh wow, that's amazing progress to be off all meds already! Thanks for assuring me it's not unusual. The overly cautious thing was abundantly clear to me post-diagnosis when my Heart Failure nurse admitted they were putting me on everything even they I didn't have water retention, high cholesterol or have blood pressure - but they had to cover themselves. Thanks again.

[JennyRx]

just to clarify aspirin is not an anticoagulant and also we shouldn’t be using the term blood thinner if possible. It’s an antiplatelet which is better description as it stops blood platelets from sticking together. It can be stopped without tapering. It sounds like the decision to stop it is based on your current clinical situation which has changed, obviously for the better. It’s good that consultants are confident to deprescribe when changes allow for that to happen, as so many patients left on repeat meds they often no longer need.

[BicuspidBloke in reply to JennyRx]

That's brilliant information and advice. And very reassuring. Thank you.

[Lowerfield_no_more in reply to JennyRx]

JennyRx Your comment about aspirin not being an anti coagulant is duly noted, and of course correct. As you say aspirin is an anti platelet, as is clopidogrel. In view of this I have edited and corrected my earlier post in this thread.

[JennyRx]

wasn’t meant as a criticism, although on a training course a fellow pharmacist got roundly told off for saying ‘blood thinner’ The nurse leading the training wasn’t having any of it. Quite rightly. And many people then get muddled between anti platelets and anticoagulants because of the misuse of the term blood thinner.

[Milkfairy Heart Star in reply to JennyRx]

Thank you for the clarification. Using the term ' blood thinners ' I agree is misleading.

My husband takes an antiplatelet clopidogrel due to his stent and a DOAC, direct oral anticoagulant as he has atrial fibrillation.