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proprophalactis eliquis therapy 4 years post mitral valve replacement

Posted by mcordeiro @mcordeiro, Mar 20 3:01pm

Had MVR in 2020, had replacement and MAZE procedure to correct Afib, which it did. After surgery I was placed on Coumadin for several months and was taken off and current take a 81 mg aspirin daily. Saw a new cardiologist last month and her recommendation to me was that I should be on proprophalactis eliquis therapy. Can anyone direct me to any studies that I can review? I'm concerned because this was the first time I heard about this and I have seen 2 cardiologist previously since my surgery.

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gloaming | @gloaming | Mar 20 3:52pm

She feels that prophylaxis (the correct spelling), meaning keeping harms at bay, or prevention, or keeping what is present and active from developing further into worse forms, is better done for your various comorbidities with a DOAC (Direct-acting Oral Anti-Coagulant) such as Xarelto or Eliquis. These novel drugs are better for the type of thrombosis you want to avoid. The three common variations of anti-thrombin action are the two which which you are familiar, but in recent years there are at least three common novel drugs that actually do a better job. So, they are all 'complementary', but are not good substitutes for each other for all conditions and comorbidities. Where aspirin is good for cardiac health and for helping to prevent stroke, it isn't so good for preventing the type of clotting we get when we are experiencing atrial fibrillation.
My advice, if you would really like it, is to do as your cardiologist/EP suggests. I have been on apixaban (Eliquis) for almost eight years by now. I may be fortunate in that I have no side effects from it, but it is generally well tolerated.
Please consider filling in the blanks in this on-line calculator truthfully and seeing what your score is. If it's higher than 2.0, I can see why you have been asked to take Eliquis. You have the right of refusal, but you must also accept the risks:
https://www.mdcalc.com/calc/40/chads2-score-atrial-fibrillation-stroke-risk

REPLY
1 reply
mcordeiro | @mcordeiro | Mar 23 7:08pm
In reply to @gloaming "She feels that prophylaxis (the correct spelling), meaning keeping harms at bay, or prevention, or keeping..." + (show)
@gloaming

She feels that prophylaxis (the correct spelling), meaning keeping harms at bay, or prevention, or keeping what is present and active from developing further into worse forms, is better done for your various comorbidities with a DOAC (Direct-acting Oral Anti-Coagulant) such as Xarelto or Eliquis. These novel drugs are better for the type of thrombosis you want to avoid. The three common variations of anti-thrombin action are the two which which you are familiar, but in recent years there are at least three common novel drugs that actually do a better job. So, they are all 'complementary', but are not good substitutes for each other for all conditions and comorbidities. Where aspirin is good for cardiac health and for helping to prevent stroke, it isn't so good for preventing the type of clotting we get when we are experiencing atrial fibrillation.
My advice, if you would really like it, is to do as your cardiologist/EP suggests. I have been on apixaban (Eliquis) for almost eight years by now. I may be fortunate in that I have no side effects from it, but it is generally well tolerated.
Please consider filling in the blanks in this on-line calculator truthfully and seeing what your score is. If it's higher than 2.0, I can see why you have been asked to take Eliquis. You have the right of refusal, but you must also accept the risks:
https://www.mdcalc.com/calc/40/chads2-score-atrial-fibrillation-stroke-risk

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Thanks for your detailed reply. I did complete the online calculator and my score is 1. I'm not opposed to take Eliquis, have taken in the past and had no adverse problems, however my cardiologist told me that even though I'm in NSR, I could convert back to afib. I was optimistically hoping that the MAZE procedure had corrected that permanently. Can you refer me to any specific studies that address my situation?
Thanks
Marie

REPLY
gloaming | @gloaming | Mar 24 3:28am

If your MAZE included closure or removal of the LAA (Left Atrial Appendage), the following might be helpful to you:
https://www.ahajournals.org/doi/10.1161/CIRCINTERVENTIONS.122.012812
Also:
https://www.researchgate.net/publication/363109955_Comparing_mid-term_outcomes_of_Cox-Maze_procedure_and_pulmonary_vein_isolation_for_atrial_fibrillation_after_concomitant_mitral_valve_surgery_A_systematic_review
And finally:
https://pmc.ncbi.nlm.nih.gov/articles/PMC8224925/
If you know you are entirely free of arrhythmia, particularly AF, I would suggest discussing going off a DOAC with your cardiologist, especially if he/she agrees that youre CHA2DS2-VASc score is under 2.0. The rationale to continue the DOAC is not erroneous, especially as we age and become more sedentary, with more sitting for example, but also if you heart has the odd short run of AF. I saw a paper not too long ago that short runs of paroxysmal AF are not as worrying, or risky, as those that go several hours or for a day or more before they convert.

REPLY
1 reply
mcordeiro | @mcordeiro | Mar 24 4:17pm
In reply to @gloaming "If your MAZE included closure or removal of the LAA (Left Atrial Appendage), the following might..." + (show)
@gloaming

If your MAZE included closure or removal of the LAA (Left Atrial Appendage), the following might be helpful to you:
https://www.ahajournals.org/doi/10.1161/CIRCINTERVENTIONS.122.012812
Also:
https://www.researchgate.net/publication/363109955_Comparing_mid-term_outcomes_of_Cox-Maze_procedure_and_pulmonary_vein_isolation_for_atrial_fibrillation_after_concomitant_mitral_valve_surgery_A_systematic_review
And finally:
https://pmc.ncbi.nlm.nih.gov/articles/PMC8224925/
If you know you are entirely free of arrhythmia, particularly AF, I would suggest discussing going off a DOAC with your cardiologist, especially if he/she agrees that youre CHA2DS2-VASc score is under 2.0. The rationale to continue the DOAC is not erroneous, especially as we age and become more sedentary, with more sitting for example, but also if you heart has the odd short run of AF. I saw a paper not too long ago that short runs of paroxysmal AF are not as worrying, or risky, as those that go several hours or for a day or more before they convert.

Jump to this post

Thanks, very helpful!
Marie

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