From the Research
Aspirin is generally not indicated for patients with severe aortic stenosis unless there are specific coexisting conditions that warrant its use. Patients with severe aortic stenosis have a fixed cardiac output due to the narrowed aortic valve, which limits their ability to increase cardiac output during times of stress or increased demand. Aspirin, being a vasodilator, can potentially cause peripheral vasodilation and reduce systemic vascular resistance, which could lead to decreased coronary perfusion pressure in these patients. This is particularly concerning because patients with severe aortic stenosis often have increased left ventricular wall stress and oxygen demand, coupled with decreased coronary perfusion.
If aspirin is needed for other indications such as coronary artery disease, a history of stroke, or peripheral arterial disease, it should be used cautiously and at the lowest effective dose (typically 81 mg daily) 1. Close monitoring for signs of hemodynamic compromise is essential. The decision to use aspirin in severe aortic stenosis should be individualized based on a careful assessment of risks versus benefits, and ideally made in consultation with a cardiologist familiar with the patient's specific condition.
Some key considerations in the management of patients with severe aortic stenosis include:
- The potential risks and benefits of antithrombotic therapy, including aspirin, in the context of transcatheter aortic valve replacement (TAVR) 2, 1
- The importance of careful monitoring and individualized decision-making in patients with severe aortic stenosis and coexisting conditions such as coronary artery disease or atrial fibrillation 3, 4
- The need for ongoing research and clinical trials to clarify the optimal management strategies for patients with severe aortic stenosis, including the use of antithrombotic therapy and TAVR 5, 1