What is the recommended aspirin (acetylsalicylic acid) regimen for patients undergoing mitral valve repair?

Aspirin Recommendations for Mitral Valve Repair

For patients undergoing mitral valve repair with a prosthetic band in normal sinus rhythm, antiplatelet therapy with aspirin 50-100 mg daily is recommended for the first 3 months over vitamin K antagonist (VKA) therapy. 1

Recommended Antithrombotic Regimen for Mitral Valve Repair

First 3 Months Post-Procedure:

• Aspirin 50-100 mg daily is the preferred antithrombotic therapy for patients in normal sinus rhythm following mitral valve repair with a prosthetic band 1
• This recommendation is based on the balance between preventing thromboembolism while minimizing bleeding risk

After 3 Months:

• Continue aspirin therapy (50-100 mg daily) indefinitely 1
• Long-term aspirin therapy is suggested to provide ongoing protection against thromboembolism

Clinical Considerations and Special Situations

Risk Factors That May Alter Management:

• Atrial fibrillation: If the patient has or develops atrial fibrillation, VKA therapy (target INR 2.5, range 2.0-3.0) should be used instead of aspirin alone 1
• Previous thromboembolism: Consider VKA therapy if the patient has a history of thromboembolism
• Hypercoagulable conditions: VKA therapy may be preferred in patients with known hypercoagulable states

Comparative Effectiveness:

• Recent research comparing VKA versus aspirin after mitral valve repair showed similar event rates (approximately 10%) during the first 3 months 2
• Thromboembolic event rates were low in both treatment groups, and major bleeding rates were comparable 2

Important Clinical Pitfalls

1. Do not use direct oral anticoagulants (DOACs) in patients with any mechanical valve components, as these are contraindicated 3

2. Monitor for bleeding complications with aspirin therapy, particularly in patients with:

   • History of gastrointestinal bleeding
   • Concurrent use of other antiplatelet or anticoagulant medications
   • Advanced age

3. Distinguish between mitral valve repair and replacement:

   • Mitral valve repair with prosthetic band: Aspirin 50-100 mg daily 1
   • Mechanical mitral valve replacement: VKA (target INR 3.0, range 2.5-3.5) plus aspirin 75-100 mg daily 1, 3
   • Bioprosthetic mitral valve replacement: VKA for first 3 months, then aspirin thereafter 1

4. Recognize when to switch from aspirin to VKA therapy:

   • Development of atrial fibrillation
   • Thromboembolic event while on aspirin therapy
   • Development of other indications for anticoagulation

By following these evidence-based recommendations, clinicians can optimize the balance between preventing thromboembolism and minimizing bleeding risk in patients undergoing mitral valve repair.