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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.
Have discussed with my Cardiologist; he recommends the Aspirin, perhaps going to every other day, but acknowldges that there is not a clear-cut answer.
Here for knowledgeable "second" opinions.
Thanks.
3 Responses
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1495448 tn?1326842830
MEDICAL PROFESSIONAL
It sounds as if your only need for anticoagulation is the prosthetic valve.  If that's the case, I wouldn't add the baby aspirin.  As long as your INR is in the therapeutic range, the aspirin will add minimal beneift and will increase your bleeding risk.  Given your very active lifestyle, you want to minimize your bleeding risk as much as possible.  Unless you have severe underlying coronary artery disease or a history of stroke, I would stick with the warfarin and skip the aspirin.  

Best of luck.
Helpful - 0
Avatar universal
I'm still hoping to get a reply from the Physicians monitoring this forum.  It's been almost 2 weeks since I posted, and have received replies same-day or so.

Just wanted to 'bump' this up to the top of the stack.

Thanks.
Helpful - 0
Avatar universal
I very much appreciate your taking the time to read through my question, and for your opinion.

I am generally a 'minimalist' and prefer to keep things as simple as possible, especially with regard to medication.  You are correct that the valve is the only reason I'm on anticoagulation.  My father and paternal grandfather had heart disease at an early age, but there is no significant history of stroke that I'm aware of.

My general life-style is dramatically different from my father's, and I'm hoping that this will outweigh the familial component of risk for heart disease (and so far, so good...).

At this point, I'm also inclined to skip the aspirin, and hope this ends up being a wise decision.
Helpful - 0

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