What are the risks of stopping aspirin (acetylsalicylic acid) in a 4-year-old patient with a history of cataract surgery?

From the Guidelines

Stopping aspirin before cataract surgery in a patient with a history of stroke or other conditions requiring aspirin therapy is not recommended due to the potential risk of thrombotic events. The provided evidence does not directly address the risks of stopping aspirin for cataract surgery in a patient with a DES placed 4 years ago, but it discusses the use of aspirin in children for secondary prevention of recurrent stroke, which implies the importance of continued antiplatelet therapy in patients at risk of thrombotic events 1. Given the potential risks, patients should continue aspirin therapy throughout the perioperative period for cataract surgery, as the risk of a thrombotic event if aspirin is discontinued far outweighs the minimal increased bleeding risk during cataract surgery. Some key points to consider include:

• The risk of thrombotic events, such as stent thrombosis, myocardial infarction, or stroke, associated with discontinuing aspirin therapy
• The minimal increased bleeding risk during modern cataract surgery, which is typically performed using topical anesthesia
• The importance of coordinating with the patient's cardiologist to develop an individualized approach if there are specific concerns about bleeding risk
• Informing the surgeon about the patient's antiplatelet therapy to prepare accordingly, though modifications to surgical technique are rarely needed for patients on aspirin alone. It is essential to prioritize the patient's cardiovascular health and continue aspirin therapy as recommended by guidelines, which generally suggest lifelong aspirin therapy for patients with a history of stroke or other conditions requiring antiplatelet protection 1.

From the FDA Drug Label

Warnings Reye's syndrome: Children and teenagers who have or are recovering from chicken pox or flu-like symptoms should not use this product, if changes in behavior with nausea and vomiting occur, consult a doctor because these symptoms could be an early sign of Reyes syndrome, a rare but serious illness Stomach bleeding warning: This product contains an NSAID, which may cause severe stomach bleeding

The risks of stopping aspirin for cataract surgery in a patient with a 4-year-old child are not directly addressed in the provided drug labels. However, considering the patient's age (assuming the patient is an adult and the 4-year-old is their child), the main concern would be the stomach bleeding warning associated with aspirin use.

• The chance of stomach bleeding is higher in certain populations, but age 4 is not a relevant factor in this context.
• There is no information about the risks of stopping aspirin for cataract surgery.
• Reye's syndrome is a concern for children and teenagers, but it is not directly related to stopping aspirin for cataract surgery. 2

From the Research

Risks of Stopping Aspirin for Cataract Surgery

• The decision to stop aspirin before cataract surgery should be made with caution, as it may increase the risk of thromboembolic events 3, 4.
• Studies have shown that continuing aspirin therapy during cataract surgery does not significantly increase the risk of serious bleeding complications, such as hyphema, retrobulbar hemorrhage, or vitreous hemorrhage 5, 6, 7.
• However, there is a slightly increased risk of subconjunctival hemorrhage associated with aspirin continuation 5.
• The benefits of continuing aspirin therapy, including the prevention of thromboembolic events, may outweigh the risks of bleeding complications 3, 4.
• It is essential to weigh the individual patient's risk factors and medical history when making a decision about aspirin therapy during cataract surgery 3, 4.

Considerations for Patients with a History of Aspirin Use

• Patients who have been taking aspirin for a long time, such as those who have undergone percutaneous coronary intervention (PCI), may be at a higher risk of thromboembolic events if aspirin is discontinued 7.
• In these cases, the risk of bleeding complications may be lower than the risk of thromboembolic events, and aspirin therapy may be continued during cataract surgery 7.
• However, each patient's situation should be evaluated individually, taking into account their medical history, risk factors, and the potential benefits and risks of continuing or discontinuing aspirin therapy 3, 4.

Age Considerations

• The studies provided do not specifically address the risks of stopping aspirin for cataract surgery in a 4-year-old patient.
• However, it is generally recommended that children undergoing cataract surgery be evaluated on a case-by-case basis, taking into account their individual medical history and risk factors.
• Aspirin is not typically used in children due to the risk of Reye's syndrome, and other antiplatelet or anticoagulant medications may be used instead 3.