Is stopping antithrombotic therapy prior to image-guide breast biopsy really necessary?
Withholding antithrombotic therapy for patients undergoing image-guided core-needle breast biopsy is likely unnecessary, according to a new analysis.
Published in Radiology, the paper details how experts arrived at this conclusion after comparing incidents of hematoma between patients who did and did not receive antithrombotic therapy prior to their procedure. After evaluating the outcomes of more than 3,000 breast biopsies, the experts found that clinically significant hematomas were rare and did not merit altered medication schedules prior to biopsy.
Corresponding author of the paper Vilert A. Loving, from the Division of Diagnostic Imaging at Banner MD Anderson Cancer Center, and colleagues explained that although the instances of bleeding complications are not common, they still warrant consideration.
“Discontinuing antithrombotic therapy is not trivial,” the authors wrote. “In patients with atrial fibrillation, 0.4% will experience thromboembolic events when temporarily stopping oral anticoagulants.”
Conversely, stopping antithrombotic therapy also has its risks, including ischemic stroke and acute myocardial infarction. This is why it is important to weigh the pros and cons for each individual patient, the authors explained.
For their study, they included a total of 3,311 image-guided core-needle biopsies—2,788 in a nonantithrombotic group and 523 in an antithrombotic group. Although the antithrombotic group had a higher overall hematoma rate of 9.4% in comparison to the other group, who had a hematoma rate of 6.2%, the figures did not reach statistical significance. Factors associated with increased incidence of hematoma were being older in age and the use of 9-gauge or larger needles.
“Because clinically significant hematomas were uncommon, withholding antithrombotic therapy before core-needle breast biopsy may be unnecessary for most patients,” the authors explained. “The medical risks of stopping antithrombotic therapy likely outweigh the small hematoma risk associated with these therapies.”
The authors of the study suggested that the factors that increase risk should be considered by providers and thoroughly discussed with patients, despite them being quite low.
The study abstract can be viewed here.
In addition to her background in journalism, Hannah also has patient-facing experience in clinical settings, having spent more than 12 years working as a registered rad tech. She began covering the medical imaging industry for Innovate Healthcare in 2021.