How long should a patient with a history of taking aspirin (acetylsalicylic acid) hold their medication before undergoing cataract extraction?

Aspirin Management Before Cataract Extraction

Aspirin should NOT be discontinued before cataract surgery—continue it throughout the perioperative period. 1, 2

Evidence-Based Recommendation

The most recent and highest quality evidence demonstrates that aspirin continuation is safe for cataract surgery:

• A 2025 systematic review and meta-analysis of 65,196 patients found that aspirin continuation increases only subconjunctival hemorrhage risk (RR: 1.74), but does NOT increase sight-threatening complications including hyphema, retrobulbar hemorrhage, vitreous hemorrhage, or visual acuity changes. 2

• The American College of Chest Physicians explicitly recommends continuing aspirin for minor procedures including cataract surgery, regardless of cardiovascular risk. 1

• The 2014 ACC/AHA perioperative guidelines specifically note that "in some instances in which there is minimal to no risk of bleeding, such as cataract surgery," anticoagulation considerations are minimal. 3

Clinical Rationale

Why Continuation is Preferred

• Thrombotic risk outweighs bleeding risk: Discontinuing aspirin in patients with cardiovascular disease increases the absolute risk of stroke or cardiovascular events by approximately 2% within 30 days. 4

• Modern surgical techniques minimize bleeding: Clear corneal phacoemulsification is particularly advantageous in patients on antiplatelet therapy, with no significant intraoperative bleeding complications. 5

• Real-world safety data: A 2023 study of patients with long-term aspirin use after percutaneous coronary intervention showed no statistically significant difference in bleeding complications during cataract surgery compared to patients not taking aspirin. 6

Specific Patient Populations

For patients with coronary stents:

• Continue aspirin throughout the perioperative period without interruption 1, 4
• If on dual antiplatelet therapy (aspirin + P2Y12 inhibitor), continue both agents as cataract surgery poses minimal bleeding risk 1

For patients on aspirin for secondary cardiovascular prevention:

• Continue aspirin perioperatively (prior MI, prior stroke, peripheral arterial disease) 1, 4

For patients on aspirin for primary prevention only:

• Can continue aspirin as bleeding risk remains minimal for cataract surgery 1

Common Pitfalls to Avoid

• Do NOT use the outdated 7-10 day discontinuation window that was previously recommended—this unnecessarily prolongs thrombotic risk without meaningful bleeding reduction. 1, 5

• Do NOT discontinue aspirin in patients with recent coronary stents (within 6-12 months for drug-eluting stents, within 4-6 weeks for bare-metal stents), as stent thrombosis risk is catastrophic. 7

• Do NOT substitute aspirin with heparin bridging—anticoagulants do not protect against stent thrombosis and actually increase bleeding risk. 7

Practical Summary

Hold time: 0 days (do not discontinue)

The overwhelming consensus from current guidelines and high-quality evidence supports aspirin continuation for cataract surgery. The only bleeding complication with increased risk—subconjunctival hemorrhage—is cosmetic and self-limited, while the thrombotic risks of discontinuation can be life-threatening. 1, 5, 2, 6