Antiplatelet Management in Cataract Surgery
Do not stop antiplatelet medications before cataract surgery—continue aspirin and other antiplatelet agents throughout the perioperative period. 1, 2
Primary Recommendation
The American College of Chest Physicians explicitly recommends continuing aspirin around the time of cataract surgery rather than stopping it 7-10 days before the procedure. 1 This applies to patients receiving aspirin for secondary prevention of cardiovascular disease. 1
Evidence Supporting Continuation
Cataract surgery is classified as a minor ophthalmologic procedure with extremely low bleeding risk, making antiplatelet continuation safe and preferable to the thrombotic risks of discontinuation. 1
Large prospective cohort data from 19,283 cataract surgeries demonstrated that hemorrhagic complications were minimal regardless of antiplatelet continuation, while thromboembolic events (stroke, TIA, deep vein thrombosis) occurred at rates of 3.8/1000 surgeries among those continuing medications versus similar rates in those who discontinued. 3
The absolute risk of both medical and ophthalmic events is so low that differences associated with stopping versus continuing antiplatelet therapy are clinically negligible. 3
Specific Antiplatelet Agents
Aspirin
- Continue throughout the perioperative period without interruption. 1, 2
- Studies show no significant increase in intraoperative bleeding with aspirin continuation, and when minor bleeding occurs, it is easily controlled with standard techniques. 4
P2Y12 Inhibitors (Clopidogrel, Prasugrel, Ticagrelor)
- Continue clopidogrel through cataract surgery following the same rationale as aspirin for minor procedures. 1
- The guideline framework for "minor dental, dermatologic, or ophthalmologic procedures" applies equally to all antiplatelet agents. 1
Dual Antiplatelet Therapy
- Continue both agents perioperatively for patients on dual antiplatelet therapy, particularly those with recent coronary stents. 1
- The risk of stent thrombosis from discontinuation far outweighs the minimal bleeding risk of cataract surgery. 1
Surgical Technique Considerations
Optimize surgical approach to minimize bleeding risk while maintaining antiplatelet therapy: 5, 6
- Use topical or intracameral anesthesia rather than retrobulbar or peribulbar needle injections, which carry higher hemorrhage risk. 5
- Clear corneal phacoemulsification is the preferred technique for patients on antiplatelet therapy. 4
- Avoid sub-Tenon or needle-based anesthetic blocks when possible. 6
Common Pitfall to Avoid
Do not discontinue antiplatelet medications "to be safe"—this paradoxically increases patient risk. 3, 6 Historical practice patterns showed 22.5% of aspirin users and 28.3% of warfarin users discontinued medications before cataract surgery, but this approach exposes patients to life-threatening thromboembolic complications without meaningful reduction in surgical bleeding risk. 3, 6