Do we give aspirin to someone s/p bioprosthetic SAVR if she is already on apixaban for unprovoked DVT?
Really no good data here – ACC guidelines say baby aspirin is a IIa (LOE B) recommendation but don’t dive deeper, and most of the literature is on patients who are anticoagulated for fib, not VTE. The attached review paper is the best answer I could find (and honestly is not much of one). My take homes are: risk of thrombosis is highest in first three months after surgery, aspirin is the winner if deciding between aspirin and warfarin, and nobody knows what to do with DOACs.
Figure 2
Papak JN, Chiovaro JC, Noelck N, et al. Antithrombotic Strategies After Bioprosthetic Aortic Valve Replacement: A Systematic Review. The Annals of Thoracic Surgery. 2019;107(5):1571-1581. doi:https://doi.org/10.1016/j.athoracsur.2018.10.016
