Heart valve surgery: Follow-up treatment
If you have surgery for heart valve repair or replacement, you will probably receive two types of medicine: anticoagulants (blood thinners) and antibiotics.
Anticoagulants
You may need to take anticoagulants for at least 3 months following heart valve surgery. During this time, you are at the greatest risk of blood clot formation around your repaired or replaced valve. These blood clots can break off and travel to your brain, causing a stroke, or to other organs, including kidneys, intestines, and legs. Taking blood thinners can prevent these clots from forming.
If your valve has been replaced with a mechanical valve, you will need to take anticoagulants indefinitely, since the artificial valve may stimulate clot formation. Some doctors also recommend taking low doses of aspirin with anticoagulants. This is primarily because aspirin has been shown to help reduce the risk of cardiovascular disease. But other doctors do not feel taking aspirin lowers your risk of cardiovascular disease enough to justify taking another medicine. Aspirin's anticlotting effect also can further increase your risk for excessive bleeding, which is already a problem due to the anticoagulants.
If your valve has been replaced with a biological valve, or if you had valve repair, you may not need to take anticoagulants for as long a time. In either case, anticoagulant therapy should be continued for 3 months following surgery. The chances of clots forming around a natural, reconstructed valve are significantly less than those of valve replacement surgery, and two-thirds of those with biological valves are able to stop taking an anticoagulant or aspirin after 3 months. But if you have a history of irregular heartbeat (atrial fibrillation) or presurgery problems with clots forming, or a dilated left atrium, you will likely need to take anticoagulants indefinitely because your risk of developing clots and having a stroke remains high.
Heart procedures such as valve surgery can also cause atrial fibrillation. Atrial fibrillation in turn can also cause clots to form, and blood-thinning medicine can help prevent these clots also.
There are risks associated with anticoagulants. You may bleed more heavily from minor injury, or even bleed spontaneously. You may need to have your medicine and blood checked regularly, and you must consult your doctor before starting or changing any of your medicines while you are on anticoagulants.
Pregnant women are generally advised not to take the blood thinner warfarin (such as Coumadin), because it is known to cause birth defects. If you become pregnant while taking warfarin, your doctor may recommend that you switch to a low-molecular-weight form of heparin (another anticoagulant) during the first and third trimesters of your pregnancy, and take warfarin only during the second trimester. Long-term use of these heparin formulations is not recommended, because it is associated with osteoporosis and thrombocytopenia.
Vitamin K can decrease the effectiveness of anticoagulants. But you should not try to eliminate vitamin K from your diet. Rather, try to make sure that your vitamin K intake remains relatively constant from day to day.
Antibiotics
If you have an artificial valve, you may need to take antibiotics before you have certain dental or surgical procedures. The antibiotics help prevent an infection in your heart called endocarditis.
| Author: | Robin Parks, MS | Last Updated: March 27, 2008 |
| Medical Review: | E. Gregory Thompson, MD - Internal Medicine Stephen Fort, MD, MRCP, FRCPC - Interventional Cardiology | |
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