From the Guidelines
Aspirin should not be held before cataract surgery in this 79-year-old patient with recent carotid artery endarterectomy, as the risk of thrombotic complications outweighs the minimal increased risk of bleeding during surgery. The patient's recent carotid endarterectomy is a significant factor in this decision, as discontinuing aspirin may increase the risk of ischemic cardiovascular events 1. According to the 2011 ASA/ACCF/AHA/AANN/AANS/ACR/ASNR/CNS/SAIP/SCAI/SIR/SNIS/SVM/SVS guideline, aspirin (81 to 325 mg daily) is recommended before carotid endarterectomy and may be continued indefinitely postoperatively (Level of Evidence: A) 1.
The patient's other medications, including amlodipine, metoprolol, valsartan, and Paxil, should be continued without interruption on the day of surgery. Proper blood pressure control is important before surgery, so the patient should take their antihypertensive medications as scheduled. The anesthesiologist should be informed about the patient's diabetes status to monitor glucose levels appropriately during the perioperative period. Key considerations for the perioperative period include:
- Continuing aspirin throughout the perioperative period to minimize the risk of thrombotic complications
- Maintaining proper blood pressure control with antihypertensive medications
- Monitoring glucose levels in patients with diabetes
- Informing the surgeon and anesthesiologist about the patient's medical history and medication use to take appropriate precautions during surgery.
From the Research
Preoperative Clearance for Cataract Surgery
- The patient is a 79-year-old with hypertension, diabetes, hyperlipidemia, and a recent carotid artery endarterectomy.
- The patient is currently taking amlodipine, metoprolol, valsartan, Paxil, and aspirin.
Aspirin Therapy
- According to 2, low-dose aspirin (75 to 325 mg) should be continued throughout the perioperative period for patients who have undergone carotid endarterectomy.
- A study published in 3 found that perioperative antiplatelet therapy was significantly associated with a decreased in-hospital stroke and death risk.
- However, 4 suggests that dual antiplatelet therapy may be associated with an increased risk of bleeding complications, and therefore, aspirin monotherapy may be preferred.
- Another study 5 found that perioperative use of aspirin for patients undergoing carotid endarterectomy is associated with a lower risk of cardiac and neurological events without a significant increase in postoperative bleeding.
Recommendations
- Based on the available evidence, it is recommended that aspirin therapy be continued in the perioperative period for this patient.
- The patient's recent carotid artery endarterectomy and current aspirin therapy suggest that continuing aspirin may be beneficial in reducing the risk of stroke and death.
- However, the decision to continue or hold aspirin therapy should be made in consultation with the patient's healthcare team, taking into account the patient's individual risk factors and medical history.
Considerations
- The patient's hypertension, diabetes, and hyperlipidemia should be well-controlled in the perioperative period to minimize the risk of cardiac and neurological complications.
- The patient's current medications, including amlodipine, metoprolol, valsartan, and Paxil, should be carefully reviewed and managed in the perioperative period to minimize potential interactions and complications.