From the Guidelines
Aspirin should not be discontinued before cataract surgery in patients receiving it for the secondary prevention of cardiovascular disease, as the risks of stopping outweigh the benefits. This recommendation is based on the American College of Chest Physicians evidence-based clinical practice guidelines, which suggest continuing aspirin around the time of cataract surgery instead of stopping it 7 to 10 days before the procedure 1. The guideline assigns a Grade 2C to this recommendation, indicating a moderate strength of evidence.
When considering the management of antithrombotic therapy in patients undergoing cataract surgery, it is essential to weigh the risks of bleeding against the risks of thrombotic events. In patients taking aspirin for secondary prevention, the risk of cardiovascular events may be higher than the risk of bleeding complications during cataract surgery.
Some key points to consider include:
- The antiplatelet effects of aspirin are irreversible and last for the lifespan of the platelet, approximately 7-10 days.
- Discontinuing aspirin may increase the risk of thrombotic events in patients with a history of cardiovascular disease.
- Many surgeons now perform cataract surgery without discontinuing aspirin, especially when using topical anesthesia and small incision techniques, as the risk of bleeding complications is relatively low.
- Patients should consult with both their ophthalmologist and the prescribing physician before making any changes to their aspirin regimen.
In general, the decision to continue or discontinue aspirin before cataract surgery should be made on a case-by-case basis, taking into account the individual patient's risk factors and medical history, as well as the surgeon's preference and expertise 1.
From the Research
Aspirin Discontinuation Before Cataract Surgery
- The decision to discontinue aspirin before cataract surgery should be made on a patient-specific basis, considering the risks of bleeding and thromboembolic events 2.
- Studies suggest that aspirin can be safely continued in patients undergoing cataract surgery, as the risk of hemorrhage is low if the international normalized ratio is in the therapeutic range 3.
- A systematic review and meta-analysis of 65,196 subjects found that continuing aspirin before cataract surgery increases the risk of subconjunctival hemorrhage, but does not significantly increase the risk of potentially sight-threatening bleeding events 4.
- The American Heart Association recommends that patients taking aspirin for primary prevention of cardiovascular disease should likely discontinue it during the perioperative period, especially when there is a high risk of bleeding 2.
- However, patients with established cardiovascular disease but without a coronary stent should likely continue aspirin during the perioperative period unless undergoing closed-space surgery 2.
- There is little evidence that continuing aspirin treatment is harmful in patients having skin surgical procedures, with the exception of warfarin therapy, where the risk of hemorrhagic complications is presumably dependent on the degree of anticoagulation 5.
Key Findings
- Aspirin can be safely continued in patients undergoing cataract surgery, with a low risk of hemorrhage 3, 4.
- The risk of subconjunctival hemorrhage is increased with aspirin continuation, but the risk of potentially sight-threatening bleeding events is not significantly increased 4.
- Patients with established cardiovascular disease should continue aspirin during the perioperative period, unless undergoing closed-space surgery 2.
- The decision to discontinue aspirin before cataract surgery should be made on a patient-specific basis, considering the risks of bleeding and thromboembolic events 2.