Should aspirin (acetylsalicylic acid) be held prior to cataract surgery?

From the Guidelines

Aspirin should typically be continued before cataract surgery rather than held, as the risk of bleeding complications during cataract surgery is minimal even with continued aspirin use 1. Patients who take aspirin for cardiovascular protection or other medical reasons should maintain their regular dosing schedule through the perioperative period. The POISE-2 trial evaluated the benefit of aspirin versus placebo in 10,010 patients undergoing non-cardiac surgery, and found that aspirin did not decrease the composite endpoint of myocardial infarction and mortality but increased the risk of major bleeding 1. However, this study had limitations, including the exclusion of patients with recent stents and those scheduled for carotid surgery. Some key points to consider when deciding whether to hold aspirin before cataract surgery include:

• The type of surgery being performed: modern cataract surgery is performed through very small incisions that are largely self-sealing, which minimizes the risk of bleeding complications
• The patient's medical history: patients who take aspirin for secondary prevention of cardiovascular events may be at increased risk if they stop taking the medication
• The potential risks and benefits of continuing or discontinuing aspirin: the risk of cardiovascular events such as heart attack or stroke must be weighed against the risk of bleeding complications during surgery In general, the benefits of continuing aspirin outweigh the risks, and patients should maintain their regular dosing schedule through the perioperative period 1. However, the final decision should always be made in consultation with both the ophthalmologist performing the surgery and the physician who prescribed the aspirin.

From the Research

Aspirin Management Before Cataract Surgery

• The decision to hold aspirin before cataract surgery is a topic of ongoing debate, with various studies providing insights into the risks and benefits associated with continuing or discontinuing aspirin therapy in this context 2, 3, 4, 5, 6.
• A study published in 2003 found that the rates of stroke, transient ischemic attack, or deep vein thrombosis were higher among patients who continued aspirin or warfarin therapy before cataract surgery, but the absolute differences in risk were minimal 2.
• In contrast, a systematic review and meta-analysis published in 2025 found that continuing aspirin therapy before cataract surgery increased the risk of subconjunctival hemorrhage, but did not significantly increase the risk of potentially sight-threatening bleeding events 3.
• Another study published in 2018 recommended that aspirin can be safely continued in patients undergoing cataract surgery, as the risk of hemorrhage associated with cataract surgery is low if the international normalized ratio is in the therapeutic range 4.
• A systematic review and meta-analysis published in 2017 found that early discontinuation of aspirin in patients with coronary artery disease undergoing surgery did not increase the risk of major adverse cardiac events, but decreased the risk of perioperative bleeding 5.
• A comprehensive update on aspirin management during noncardiac surgery published in 2020 suggested that patients taking aspirin for primary prevention of cardiovascular disease should likely discontinue it during the perioperative period, while patients with established cardiovascular disease should continue aspirin unless undergoing closed-space surgery 6.

Risks and Benefits of Aspirin Continuation

• The risks of continuing aspirin therapy before cataract surgery include an increased risk of subconjunctival hemorrhage 3 and potentially other bleeding complications.
• The benefits of continuing aspirin therapy before cataract surgery include a potential reduction in the risk of thromboembolic events, such as stroke or deep vein thrombosis 2, 4.
• The decision to continue or discontinue aspirin therapy before cataract surgery should be made on a patient-specific basis, taking into account the individual's cardiovascular risk factors and the potential risks and benefits of aspirin therapy 6.

Clinical Recommendations

• Patients undergoing cataract surgery should discuss their aspirin therapy with their surgeon and anesthesiologist to determine the best course of action 3, 4, 6.
• The decision to continue or discontinue aspirin therapy before cataract surgery should be based on a careful evaluation of the patient's individual risk factors and the potential risks and benefits of aspirin therapy 2, 5, 6.