Antithrombotic Therapy: Evaluation of the Safety of Performing Core Needle Biopsy of the Breast Without Suspending Medication

Cameron, Patrice; Lesko, Jana; London, Marla R.

doi:10.1188/18.cjon.e18-e22

Cited by 11 publications

(2 citation statements)

References 14 publications

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“…In this latter study, the authors defined hematomata as clinically significant if they caused significant post-procedure discomfort or required clinical follow-up, surgical or percutaneous drainage, or hospital admission. A recent study by Cameron et al [21] from 2018 (with only n = 42 patients) found no post-discharge bleeding after CNB in patients who were on anti-thrombotic therapy. All these above-mentioned studies display high variability in their design (including follow-up), in the investigated medication regimens, and in the biopsy methods used (modality and gauges), which impedes comparing or generalizing their results [13].…”

Section: Discussionmentioning

confidence: 99%

Management of Patients with Breast Biopsy under Anti-Coagulation or Anti-Platelet Therapy: Results of a Survey of German Experts

Riedel,

Hahn,

Bader

et al. 2024

Breast Care

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Introduction Pre-therapeutic histologic diagnosis through image-guided core needle biopsy (CNB) or vacuum-assisted biopsy (VAB) for suspicious breast findings is a standard procedure. Despite the moderate risk of bleeding, a significant proportion of patients are on temporary or permanent anti-coagulation therapy (ACT) or anti-platelet therapy (APT). Currently, there are no established guidelines for managing biopsies in such patients, leading to varying approaches in clinical practice. Methods An online survey was conducted among all members of the breast ultrasound working group at the German Society for Ultrasound in Medicine (DEGUM) and the working group for breast diagnostics at the German Radiology Society (DRG). It included n=51 questions about individual risk perception of biopsy-related bleeding complications and the specific management of biopsies on ACT/APT. Results A total of 332 experts participated, with 51.8% reporting the absence of a standardized management plan for breast biopsies on ACT/APT. Concerning specific ACT/APT medications, the survey revealed discrepancies in risk perception and management: The majority preferred discontinuing medication with directly acting oral anti-coagulants (DOACs; CNB: 66.9%; VAB: 91.1%), phenprocoumon (CNB: 74.9%; VAB: 96.7%), or therapeutic heparin (CNB: 46.1%; VAB: 72.7%). However, there was a lower inclination to discontinue acetylsalicylic acid (ASA; CNB: 15.2%; VAB: 50.3%) or prophylactic heparin (CNB: 11.9%, VAB: 36.3%). Conclusion Breast biopsies for patients on ASA or prophylactic heparin are deemed safe and part of standard clinical practice. However, despite available feasibility studies, conducting breast biopsies on ACT medications such as DOACs or phenprocoumon appears feasible only for a minority of experts.

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Section: Discussionmentioning

confidence: 99%

Management of Patients with Breast Biopsy under Anti-Coagulation or Anti-Platelet Therapy: Results of a Survey of German Experts

Riedel,

Hahn,

Bader

et al. 2024

Breast Care

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“…Thus, extrapolation of these results to patients on anticoagulants or multiple agents is cautioned. Another more recent study of 42 patients on various anticoagulants (including 5 on a direct oral anticoagulant [DOAC]) undergoing breast core biopsy, a 4% rate of self‐reported hematoma (classified as not clinically significant) was reported when anticoagulants were continued 13 …”

Section: Management Of Antithrombotic Agentsmentioning

confidence: 99%

Peri‐procedure management of antithrombotic agents and thrombocytopenia for common procedures in oncology: Guidance from the SSC of the ISTH

Wang

Sanfilippo

Douketis

et al. 2022

Journal of Thrombosis and Haemostasis

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Patients with cancer have an increased risk of thrombosis requiring anticoagulants and/or antiplatelet agents, and they can also encounter thrombocytopenia due to cancer itself or cancer therapies. They often undergo many procedures such as tissue or bone marrow biopsies, placement of central access lines, diagnostic or therapeutic draining procedures, lumbar puncture, and more. Management of antithrombotic agents or thrombocytopenia around the time of these procedures is highly variable.In this document, the Hemostasis and Malignancy Subcommittee of the International Society on Thrombosis and Haemostasis aims to provide useful practice guidance in the management of antithrombotic agents and thrombocytopenia around the time of common procedures in patients with cancer.

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Bleeding risk after percutaneous breast needle biopsy in patients on anticoagulation therapy

2021

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Antithrombotic Therapy: Evaluation of the Safety of Performing Core Needle Biopsy of the Breast Without Suspending Medication

Abstract: None of the 42 women who completed core needle biopsy of the breast while on antithrombotic therapy reported postdischarge bleeding, and 2 reported hematoma, supporting the safety of continuing antithrombotic therapy in patients who undergo core needle biopsy of the breast.

Cited by 11 publications

References 14 publications

Management of Patients with Breast Biopsy under Anti-Coagulation or Anti-Platelet Therapy: Results of a Survey of German Experts

Management of Patients with Breast Biopsy under Anti-Coagulation or Anti-Platelet Therapy: Results of a Survey of German Experts

Peri‐procedure management of antithrombotic agents and thrombocytopenia for common procedures in oncology: Guidance from the SSC of the ISTH

Bleeding risk after percutaneous breast needle biopsy in patients on anticoagulation therapy

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