Although patients are routinely advised not to take aspirin before surgical procedures — to reduce the risk of postoperative bruising, bleeding and hemorrhage — this may not be necessary for people undergoing upper eyelid surgery, according to a study published in Ophthalmic Plastic Reconstructive Surgery.

Across most surgical subspecialties, aspirin has been routinely discontinued 1 to 2 weeks before elective surgical interventions to allow adequate time for the production of new platelets and elimination of the anti-coagulation properties of aspirin.

Researchers carried out a first-of-its-kind randomized, placebo-controlled study on 48 patients undergoing upper eyelid surgery. People who required procedures to fix drooping or sagging upper eyelids and who were also taking 81mg of aspirin for preventative health reasons, with no history of cardiovascular disease or thrombotic disorders, were considered for the study. Those who didn’t take aspirin daily or were on blood thinner medication were excluded.


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A random number generator assigned a number for each patient between 1 and 100. Odd numbered patients were given aspirin; even numbered patients were given a placebo. Each patient was given 7 capsules and asked to take them the week before their surgery and to stop taking their typical aspirin regimen 7 days before surgery. Aspirin tabs for the study group (and saccharin tabs for the placebo group) were placed in empty gel capsules.

Next, the participants were evaluated at their first postoperative appointment, with researchers taking photos to document the bruising around their eyes and asking them questions about any postoperative bleeding or hemorrhage they might have experienced.

Of the 48 patients who took part, 29 were included in the aspirin group and 19 were in the placebo group. In the aspirin group, the age ranged from 56 to 78 and 13 of the participants were male (44.8%). Ages in the placebo group ranged from 57 to 80 and 8 were male (42.1%). There was no statistically significant difference in the age or sex between the 2 groups (P =.64 and P =.85, respectively) or in ethnicities between groups (P =.11).

When the researchers looked at the bruising experienced by patients in the aspirin group, 9 eyelids were graded as “none” (17.3%), 20 eyelids were “mild” (38.5%), 23 were “moderate” (44.2%) and none were “severe.” In the placebo group, 3 lids were graded as “none” (8.1%), 17 lids were “mild” (45.9%), 15 lids were “moderate” (40.6%) and 2 were graded “severe” (5.4%).

Researchers found no statistically significant difference in the amount of postoperative bruising patients experienced whether they were in the aspirin or placebo group. This suggests that it isn’t necessary for patients to stop taking small doses of aspirin before upper eyelid surgery, and the research team feels the current guidelines should be updated to reflect this.

Reference 

Winkler K, Beaulieu R, Bevill L, Mishulin A, Black E. Effects of aspirin on postoperative bruising and bleeding complications in upper eyelid surgery. 2020;36(6):575-578. Ophthalmic Plast Reconstr Surg. doi: 10.1097/IOP.0000000000001652.