Do I need to stop taking aspirin (acetylsalicylic acid) before undergoing cataract surgery?

Aspirin Management for Cataract Surgery

Aspirin should be continued throughout the perioperative period for patients undergoing cataract surgery. 1

Evidence-Based Rationale

The American College of Chest Physicians (ACCP) provides clear guidance on this matter in their evidence-based clinical practice guidelines. They specifically recommend continuing aspirin around the time of cataract surgery rather than stopping it 7-10 days before the procedure 1. This recommendation is based on the following considerations:

• The risk of bleeding complications during cataract surgery is very low even with continued aspirin use
• The potential cardiovascular risks of stopping aspirin outweigh the minimal bleeding risks
• Modern cataract surgical techniques minimize bleeding complications

Bleeding Risk Assessment

The most recent and comprehensive evidence from a 2025 systematic review and meta-analysis of 65,196 patients confirms the safety of continuing aspirin during cataract surgery 2. While this analysis showed:

• Increased risk of subconjunctival hemorrhage with aspirin continuation (RR: 1.74)
• No increased risk of sight-threatening bleeding events including:
  • Hyphema
  • Retrobulbar hemorrhage
  • Vitreous hemorrhage
  • Posterior capsule rupture

These findings align with earlier research showing that aspirin intake was not associated with significant intraoperative bleeding during cataract surgery 3.

Cardiovascular Risk Considerations

Discontinuing aspirin therapy carries potential cardiovascular risks:

• Retrospective studies show aspirin withdrawal precedes up to 10.2% of acute cardiovascular syndromes 4
• The time interval between discontinuation and acute coronary syndromes averages 8.5 ± 3.6 days 4
• A rebound hypercoagulable state may occur after aspirin discontinuation 5

Specific Recommendations for Different Patient Groups

1. Patients on aspirin for secondary prevention (established cardiovascular disease):

   • Continue aspirin throughout the perioperative period 1, 6
   • The cardiovascular benefits clearly outweigh the minimal bleeding risks

2. Patients with coronary stents:

   • Absolutely continue aspirin during cataract surgery 1
   • For patients on dual antiplatelet therapy (DAPT), continue aspirin and consult with cardiology regarding P2Y12 inhibitor management 1

3. Patients on aspirin for primary prevention only:

   • Even in these lower-risk patients, aspirin can be safely continued during cataract surgery 2

Practical Considerations for Surgeons

• Inform the ophthalmologist about the patient's aspirin therapy before surgery
• Consider clear corneal phacoemulsification technique, which is advantageous in patients receiving antiplatelet therapy 3
• Topical or intracameral anesthesia is preferred over injected anesthesia 7
• Have appropriate hemostatic measures available if needed

Common Pitfalls to Avoid

1. Unnecessary discontinuation: The most common error is stopping aspirin when it's not needed, exposing patients to cardiovascular risks without meaningful reduction in bleeding complications.

2. Inadequate communication: Failure to inform the surgical team about continued aspirin therapy may lead to unpreparedness for potential (though rare) bleeding issues.

3. Inconsistent recommendations: Patients may receive conflicting advice from different providers about aspirin management, leading to confusion and potential non-adherence to important cardiovascular medications.

In conclusion, the evidence strongly supports continuing aspirin therapy for patients undergoing cataract surgery, as the cardiovascular benefits outweigh the minimal bleeding risks, and modern surgical techniques can effectively manage any minor bleeding that might occur.