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Warfarin with or without Aspirin: St. Jude Mitral Valve

I am 59; had St. Jude Mitral Valve Replacement 20 years ago following Acute Bacterial Endocarditis (had pre-existing Mitral Valve Prolapse, exact etiology of this incident never identified).  Have been on Coumadin, well-controlled, with INR 2.5-3.5 throughout, with no significant incidents.
Normal Sinus Rhythm.  Normal Echo and Left Atrial dimensions. Mild HBP, well controlled, Cholesterol 166 with Lipitor 10mg QD.
Extremely active physically (competitive volleyball, 2 to 6 hours/week for the last 20 years, generally with men half my age).
My question concerns the pros and cons of adding a baby aspirin to the Coumadin therapy, mainly with respect to stroke prevention.  My level of physical activity does increase bleeding risks somewhat in terms of musculoskeletal injury, and I am aware of the risk for G.I. bleed being increased with Aspirin as well.
I am not your "average" Prosthetic Valve patient - no atrial fib, normal left atrial size, high level of fitness and activity, and wonder if the added benefit documented in some studies through the addition of aspirin applies to me, or if I am in a different clinical population, where the added risk of bleeding really wouldn't be offset by lower risk of stroke.
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1137980 tn?1281285446
Hi read your post again...sorry you aren't getting the answers from the expert forum however my understanding is that Medhelp has a new site called "Ask a Doctor Live" where you are on the site and a doc answers your questions live time...i haven't gone onto the site yet because i am a community leader for one of the other heart sites and simply put just don't have time.  As far as long term effects go the info that i received came from the Medscape Today monthly  where i think you may be able to find the answers and it falls under Hepatic Dysfunction.  Also i found some pretty interesting articles and papers that were written by docs and scientists at pmep.cce.cornell as well as at extoxnet.orst.  As far as generalized organ damage that concerns me goes i am not currently on any blood thinners other then as aspirin a day as a safety net but i think unless i am mistaken that there is so much controversy over the use of coumadin and in speaking w. my heart surgeon many docs are not supporters of the med and liken it to the term rat poison because the effects are pretty much the same (i know that is super extreme) however hopefully there will be something put out there in our near future that will have the benefits of heparin/coumadin without all of the backlash of the drugs.  There is so much written on blood thinners now and i guess we have to weigh out the benefits vs. the possible side effects.  I can't help but believe that someday probably when we are all gone that use of those two meds will seem barbaric....try the Ask The Doctor Live site....the Medhelp Leaders are touting it as a great site and maybe today i'll be able to get to it and see what is really going on...have a great rest of your weekend....
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Avatar universal
Will do.

Nothing so far.  In looking at the Posts in that forum, it seems like quite a few receive no expert replies whatsoever, even weeks after they were posted.  Kind of discouraging.  Little point in having a forum like that, if the physicians/experts aren't going to consistently provide answers/opinions.

Oh well, we'll see.

Looking back at your post, I see your reference to "long term effects to our organs" from anticoagulation.  I am a physician as well, though not a cardiologist, and haven't come across anything suggesting any kind of subtle, 'insidious' damage from long-term anticoagulation.  It's mainly the risk of spontaneous bleeding, or excessive bleeding from injury, or other disease processes, that are clearly problematic.

Do you have any literature references that suggest the potential for the type of generalized organ damage that concerns you?

Thanks, and good luck!
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1137980 tn?1281285446
Hey do me a favor will you re post what the opinions were that they came up with?  I would be curious to know.....
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Avatar universal
Thanks for your reply and thoughts.

I posted here initially, as the "expert" forum wasn't allowing me to submit there (the daily maximum had been reached).  I just checked again, and this time it let me in, so I went ahead and posted there.

Will be interested to see what opinions I get.
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1137980 tn?1281285446
It would seem to me that if i were you i would toss this question past the doc and get their opinion mainly because we need to maintain a specific blood content in our bodies in terms of viscosity within our bodies or we can be in a world of hurt.  Stoke is a biggie for anyone however to me with our blood being too thin can cause some long term effects to our organs not to mention the issues w. the possiblity of bleeding out, bruising, nosebleeds, etc.  Just a thought
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