Blood Thinners & Tissue Heart Valves: What Should Patients Know?

Perhaps one of the most significant concerns and considerations for patients anticipating heart valve replacement surgery is whether they will need to take blood thinning medications for the rest of their lives.

For many patients, it can be the deciding factor in which valve to choose – a mechanical valve or tissue valve – as blood thinners come with various risks and side effects that patients must manage throughout their lifetime. Mechanical valves require blood thinners to prevent blood clots from forming. Tissue valves don’t necessarily require anticoagulation, but certain conditions associated with heart valve disease or other health problems may still necessitate the use of blood-thinning medication for patients.

We receive many patient questions about heart valve surgery and blood thinners. For example, Shirley just asked us, “I’ve read that patients who get tissue valves may go on blood thinners after heart surgery. Is that true? I thought that blood thinners were only for mechanical valve replacement patients.” To answer Shirley’s question, we met with Dr. Marc Gerdisch, the Chief of Cardiac Surgery at Franciscan Health in Indianapolis, Indiana. Dr. Gerdisch has become one of the most beloved surgeons in our community, having successfully treated more than 100 patients at HeartValveSurgery.com.

Blood Thinners After Tissue Valve Replacement Surgery

Here are the key insights shared by Dr. Gerdisch:

• Data shows that patients with tissue valves often need anticoagulation. “It’s a very insightful question and a very important one,” said Dr. Gerdisch. “If we look at the larger data for transcatheter valves and tissue valves, approximately 30 percent of patients with tissue valves, of either type, are anticoagulated. So, that’s not just anti-platelet agents like aspirin or Plavix, but patients are taking either Warfarin or a Direct-Acting Oral Anticoagulant (DOAC), such as Eliquis, which actively thins your blood. The reason for this is that they have other conditions that require it. So, they might develop atrial fibrillation or have underlying left ventricular dysfunction.” Other events that may require anticoagulation include pulmonary embolism, a blood clot in the lungs, and deep vein thrombosis (DVT), a clot in the legs. Dr. Gerdisch said anticoagulation is also required as tissue valves begin to thicken and move closer to failure.

• It’s essential for patients to consider the medical research. “There is a great paper from several years ago that shows a diagram that fundamentally tells us that we’re probably not anti-coagulating as many people as we’re supposed to,” said Dr. Gerdisch. “People with tissue valves who have other conditions require it. For mechanical valves, you must be on the blood thinner Coumadin. It is the only drug we can use for mechanical valves. We just published our five-year data showing that we can reduce the dose dramatically, where patients can have an INR of 1.5 to 2.0 with the On-X mechanical valve specifically, but they must be anti-coagulated, and that needs to be followed.”

Thanks Dr. Gerdisch and Franciscan Health!

On behalf of all the patients in our community, thanks to Dr. Marc Gerdisch, for everything you and your team are doing at Franciscan Health in Indianapolis, Indiana!

Related Links:

• Research Alert: New 5-Year Safety Data on On-X Mechanical Aortic Valve at Low INR
• Surgeon Q&A: Rapid Recovery Protocol 2.0
• Free Heart Valve eBook: Ask Dr. Gerdisch Anything

Keep on tickin,
Adam

P.S. For the deaf and hard-of-hearing members of our patient community, we have provided a written transcript of our interview with Dr. Gerdisch below.