Do patients need to stop taking antiplatelet (anti-clotting) medications, such as aspirin, clopidogrel (Plavix), or ticagrelor (Brilinta), before undergoing cataract surgery?

Antiplatelet Management for Cataract Surgery

No, antiplatelets do not need to be stopped before cataract surgery—they should be continued throughout the perioperative period. Cataract surgery is classified as a low-bleeding-risk procedure that can be safely performed even in patients on dual antiplatelet therapy. 1

Evidence-Based Recommendation

Continue all antiplatelet medications (aspirin, clopidogrel, ticagrelor) without interruption for cataract surgery. Multiple high-quality guidelines explicitly classify cataract surgery as a low-risk bleeding procedure where antiplatelet continuation is safe and recommended. 1

Key Supporting Evidence

• The 2018 French Working Group on Perioperative Haemostasis (GIHP) and French Study Group on Thrombosis and Haemostasis (GFHT) guidelines explicitly list cataract surgery among procedures carrying low bleeding risk that are "feasible in patients on dual antiplatelet therapy." 1

• The 2012 American College of Chest Physicians (ACCP) guidelines specifically recommend "continuing VKAs around the time of cataract surgery instead of other strategies," establishing the low-risk nature of this procedure even with anticoagulation. 1

• The 2022 ACCP guidelines reinforce that low-to-moderate bleeding risk procedures can proceed with continued antiplatelet therapy. 1

Clinical Trial Data

Multiple prospective studies demonstrate the safety of continuing antiplatelets during cataract surgery:

• A 1998 randomized study of 61 patients on aspirin found no significant differences in bleeding complications whether aspirin was continued, stopped 2-5 days before surgery, or stopped 7-10 days before surgery. 2

• A 2011 prospective study of 51 eyes in patients on combined warfarin plus antiplatelet therapy (aspirin or clopidogrel) showed zero hemorrhagic complications when medications were continued. 3

• A 2025 meta-analysis of 65,196 patients found that aspirin continuation increased only subconjunctival hemorrhage risk (RR: 1.74), but did not increase sight-threatening complications including hyphema, retrobulbar hemorrhage, vitreous hemorrhage, or visual acuity changes. 4

Surgical Technique Considerations

Use topical or intracameral anesthesia with clear corneal incision to minimize bleeding risk:

• Avoid needle-based regional or retrobulbar blocks, as these carry higher bleeding risk in anticoagulated patients. 5, 3

• Clear corneal phacoemulsification is the preferred technique for patients on antiplatelet therapy. 2, 3

• Topical needle-free anesthesia eliminates the risk of retrobulbar hemorrhage entirely. 5, 3

Critical Safety Consideration

The thrombotic risk of stopping antiplatelets far exceeds the minimal bleeding risk of cataract surgery:

• Discontinuing antiplatelet therapy before cataract surgery may increase the risk of life-threatening thromboembolic events (myocardial infarction, stroke, stent thrombosis). 5, 6

• The bleeding that may occur during cataract surgery is minor, easily controlled, and does not threaten vision or life. 2, 3, 4

• For patients with recent coronary stents, stopping P2Y12 inhibitors can precipitate catastrophic stent thrombosis with mortality rates exceeding 20%. 6

Common Pitfalls to Avoid

Do not routinely stop antiplatelets "just to be safe"—this actually increases patient risk. The outdated practice of stopping all antiplatelet medications 5-10 days before any surgery has been definitively shown to cause more harm than benefit for low-risk procedures like cataract surgery. 1, 6

Do not use platelet function testing to guide management. The 2022 ACCP guidelines explicitly recommend against routine platelet function assays, as they do not improve outcomes. 1, 7

Do not delay cataract surgery to allow antiplatelet washout. This exposes patients to unnecessary thrombotic risk and delays vision restoration without meaningful benefit. 5

Special Populations

For patients on dual antiplatelet therapy (DAPT) after recent stent placement:

• Continue both aspirin and P2Y12 inhibitor without interruption. 1, 7

• Cataract surgery is explicitly listed as safe even with DAPT. 1

• The risk of stent thrombosis from stopping DAPT vastly outweighs any bleeding risk. 6

For patients on triple therapy (anticoagulant plus DAPT):

• Continue all medications if INR is in therapeutic range. 1, 3

• Use topical anesthesia and clear corneal technique. 3