Do we need to hold aspirin before vitreoretinal surgery? A systematic review and meta-analysis

To evaluate the safety of aspirin continuation versus discontinuation in patients undergoing vitreoretinal surgery by assessing hemorrhagic complications and visual outcomes. The review protocol was prospectively registered in PROSPERO (CRD420251270694). A systematic review and meta-analysis was conducted following PRISMA guidelines. PubMed, Scopus, Ovid, and Web of Science were searched from inception through August 31, 2025. Studies comparing aspirin continuation versus discontinuation or no aspirin use in adult patients undergoing vitreoretinal surgery were included. The primary outcome was vitreous hemorrhage. Secondary outcomes included hyphema, subconjunctival hemorrhage, subretinal hemorrhage, choroidal hemorrhage, retinal hemorrhage, and visual acuity changes. Risk ratios (RR) with 95% confidence intervals (CI) were calculated using random-effects models. Quality assessment was performed using the Newcastle-Ottawa Scale, and certainty of evidence was rated using the GRADE framework. Seven studies comprising 2,889 surgical procedures (2,873 patients) were included. Aspirin continuation was not associated with significantly increased risk of vitreous hemorrhage (RR 1.55, 95% CI: 0.73–3.29, p = 0.253, I²=61.7%), hyphema (RR 1.52, 95% CI: 0.56–4.17, p = 0.415, I²=0.0%), subconjunctival hemorrhage (RR 1.20, 95% CI: 0.58–2.48, p = 0.622, I²=0.0%), subretinal hemorrhage (RR 1.06, 95% CI: 0.15–7.63, p = 0.956, I²=82.4%), choroidal hemorrhage (RR 2.07, 95% CI: 0.81–5.24, p = 0.127, I²=0.0%), retinal hemorrhage (RR 1.68, 95% CI: 0.33–8.52, p = 0.532, I²=73.6%), or postoperative visual acuity (MD = 0.26 logMAR, 95% CI: −0.005 to 0.52; p = 0.055). Included studies were rated as moderate to high quality on the Newcastle-Ottawa Scale. GRADE certainty of evidence was rated as low to very low across all outcomes. Aspirin continuation appears safe in vitreoretinal surgery, with low risk of hemorrhagic complications. Given aspirin’s thrombotic benefits, it can likely be continued in most patients. However, this conclusion, based on low-certainty evidence, should be interpreted with caution and requires confirmation from high-quality prospective randomized trials.