Aspirin and upper lid surgery
Reviewed by James Hsuan

This is a double-blind randomised controlled trial of preoperative aspirin versus placebo in patients undergoing upper lid blepharoplasty or ptosis surgery. All enrolled patients were already taking aspirin and no other anti-platelet or anticoagulant drugs. All patients either had no history of cardiovascular or thrombotic disease or were given clearance by the prescribing physician to temporarily cease aspirin. Although 98 patients were enrolled, only 48 completed the study, comprising 29 in the aspirin group (52 eyelids) and 19 in the placebo group (37 eyelids). The former continued their normal daily dose of 81mg aspirin and the control group were given a placebo in the week before surgery. Surgeons graded intraoperative bleeding and independent blinded reviewers assessed postoperative bruising. Although a large number of patients were lost from the study, the number completing the trial was adequate to find a significant result according to the power calculation. There were no differences in age, race or sex between the two groups. In the aspirin group there were 14 ptosis repairs, 18 ptosis repairs with blepharoplasty, and 20 blepharoplasties, and in the placebo group there were 11, 19 and seven eyelids respectively. In both groups there were three patients who reported mild oozing postoperatively, but no serious bleeding complications or thromboembolic events. There was no statistically significant difference in the intraoperative or postoperative bleeding, nor in the bruising grading, between the two groups. Although this is a commonly discussed issue, this is the first randomised controlled trial investigating aspirin cessation in upper lid surgery. Another study reported that 57% of oculoplastic surgeons routinely stop aspirin prior to ptosis surgery, and the authors suggest that the risks of stopping outweigh the risks of continuing. They do point out that lower lid blepharoplasties are associated with a higher bleeding complication rate, and limit their advice to upper lid surgery.

Effects of aspirin on postoperative bruising and bleeding complications in upper eyelid surgery.
Winkler KP, Beaulieu R, Bevill L, et al.
OPHTHALMIC PLASTIC AND RECONSTRUCTIVE SURGERY
2020;36:575-8.