What medications are prescribed after aortic root replacement?

From the Guidelines

Medications prescribed after aortic root replacement typically include anticoagulants and antiplatelet agents.

Medication Options

• Warfarin: an anticoagulant that may be prescribed for 3 to 6 months after surgery to achieve a target INR of 2.0-3.0, especially in patients with risk factors 1.
• Aspirin: an antiplatelet agent that may be prescribed in low doses (75-100 mg daily) as an alternative to anticoagulant therapy or in addition to warfarin 1.

Specific Considerations

• The use of warfarin or aspirin depends on the type of valve replacement (bioprosthetic or mechanical) and the patient's individual risk factors 1.
• The first postoperative month is a high-risk period for thromboembolism, and anticoagulant therapy may be initiated during this time 1.
• Low-molecular-weight heparin (LMWH) or unfractionated heparin (UFH) may be used as a bridge to warfarin therapy 1.
• Novel oral anticoagulants (NOACs) may be considered in patients with atrial fibrillation associated with a bioprosthesis after the third postoperative month 1.

From the Research

Medications Prescribed After Aortic Root Replacement

The medications prescribed after aortic root replacement vary depending on the individual patient's condition and the type of replacement surgery performed.

• Antithrombotic medications are commonly prescribed to prevent thromboembolic complications, with aspirin being the most commonly used antithrombotic strategy after bioprosthetic aortic valve replacement (bAVR) 2.
• Other antithrombotic medications that may be prescribed include warfarin, dual antiplatelets, and oral anticoagulation (OAC) plus antiplatelet therapy 2, 3.
• The choice of antithrombotic therapy depends on various patient and procedure-related factors, including the risk of ischemic and bleeding complications 3.
• In some cases, medications such as vasodilators, ACE inhibitors, and beta-blockers may be prescribed to manage conditions such as aortic insufficiency, hypertension, and aortic root disease 4, 5.
• The use of cryopreserved aortic allografts in aortic root replacement surgery may also influence the choice of medications prescribed post-operatively 6.

Specific Medications

Some specific medications that may be prescribed after aortic root replacement include:

• Aspirin: to prevent thromboembolic complications 2, 3
• Warfarin: to prevent thromboembolic complications, especially in patients with a history of atrial fibrillation or other conditions that increase the risk of thromboembolism 2, 3
• Dual antiplatelets: to prevent thromboembolic complications, especially in patients who have undergone recent stenting 3
• Oral anticoagulation (OAC) plus antiplatelet therapy: to prevent thromboembolic complications, especially in patients with a history of atrial fibrillation or other conditions that increase the risk of thromboembolism 3
• Vasodilators: to manage aortic insufficiency and reduce the risk of heart failure 5
• ACE inhibitors: to manage hypertension and reduce the risk of heart failure 5
• Beta-blockers: to slow the rate of aortic dilatation and delay the need for surgery in patients with aortic root disease 5