Original Research
Breast Imaging
May 10, 2023

Bleeding Events After Image-Guided Breast Biopsies: Comparison of Patients Temporarily Discontinuing Versus Maintaining Antithrombotic Therapy During Biopsy

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Abstract

BACKGROUND. Antithrombic (AT) therapy is commonly temporarily discontinued before breast core needle biopsy (CNB), introducing risks of thrombotic events and diagnostic delay.
OBJECTIVE. The purpose of this article was to compare the frequency of postbiopsy bleeding events among patients without AT use, patients temporarily discontinuing AT therapy, and patients maintaining AT therapy during breast CNB.
METHODS. This retrospective study included 5302 patients (median age, 52 years) who underwent image-guided breast or axillary CNB between January 1, 2014, and December 31, 2019. From January 1, 2014, to December 31, 2016, patients temporarily discontinued all AT therapy for 5 days before CNB; from January 1, 2017, to December 31, 2019, patients maintained AT therapy during CNB. Immediate postbiopsy mammograms were reviewed for imaging-apparent hematoma. Patients were called 24–48 hours after biopsy and asked regarding palpable hematoma and breast bruise. The EMR was reviewed for clinically significant postbiopsy hematoma (i.e., hematoma requiring drainage, primary care or emergency department visit for persistent symptoms, or hospital admission). Bleeding events were compared among groups, including Firth bias-reduced multivariable logistic regression analysis.
RESULTS. During CNB, 4665 patients were not receiving AT therapy, 423 temporarily discontinued AT therapy, and 214 maintained AT therapy. Imaging-apparent hematoma occurred in 3% of patients without AT use, 6% of patients discontinuing AT therapy, and 7% of patients maintaining AT therapy (p = .60 [discontinuing vs maintaining]). Palpable hematoma occurred in 2% of patients without AT use, 4% of patients maintaining AT therapy, and 4% of patients discontinuing AT therapy (p = .92 [discontinuing vs maintaining]). Breast bruise occurred in 2% of patients without AT use, 1% of patients discontinuing AT therapy, and 6% of patients maintaining AT therapy (p < .001 [discontinuing vs maintaining]). In multivariable analysis adjusting for age, biopsy imaging modality, needle gauge, number of biopsy samples, and pathologic result, discontinued AT therapy (using maintained AT therapy as reference) was not a significant independent predictor of imaging-apparent hematoma (p = .23) or palpable hematoma (p = .91) but independently predicted decreased risk of bruise (OR = 0.11, p < .001). No patient developed clinically significant postbiopsy hematoma.
CONCLUSION. Frequencies of imaging-apparent and palpable hematoma were not significantly different between patients temporarily discontinuing versus maintaining AT therapy.
CLINICAL IMPACT. The findings support the safety of continuing AT therapy during CNB. Patients who maintain AT therapy should be counseled regarding risk of bruise.

Highlights

Key Finding
Imaging-apparent hematoma occurred in 3%, 6%, and 7%; palpable hematoma in 2%, 4%, and 4%; and breast bruise in 2%, 1%, and 6% of patients without AT use, patients discontinuing AT therapy, and patients maintaining AT therapy, respectively, during breast CNB. No patient developed clinically significant hematoma after biopsy.
Importance
Findings support the overall safety of maintaining AT therapy during breast CNB and should be considered in development of institutional policies and professional guidelines.

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Information & Authors

Information

Published In

American Journal of Roentgenology
Pages: 438 - 449
PubMed: 37162038

History

Submitted: February 11, 2023
Revision requested: February 27, 2023
Revision received: March 28, 2023
Accepted: May 1, 2023
Version of record online: May 10, 2023

Keywords

  1. anticoagulant
  2. bleeding
  3. breast imaging
  4. core needle biopsy
  5. hematoma

Authors

Affiliations

Melissa B. Reichman, MD [email protected]
Department of Radiology, Weill Cornell Medicine at New York-Presbyterian Hospital, 525 E 68th St, New York, NY 10065.
Paige McMahon, MD
Weill Cornell Medical School, New York, NY.
Michaela Dwyer, BA
Weill Cornell Medical School, New York, NY.
Se Jung Chang, BA
Weill Cornell Medical School, New York, NY.
Hung Lin, MD
Radia Inc., PS, Lynnwood, WA.
Janine Katzen, MD
Department of Radiology, Weill Cornell Medicine at New York-Presbyterian Hospital, 525 E 68th St, New York, NY 10065.
Charlene Thomas, MS
Department of Population Health Sciences, Weill Cornell Medicine, New York, NY.
Michele B. Drotman, MD
Department of Radiology, Weill Cornell Medicine at New York-Presbyterian Hospital, 525 E 68th St, New York, NY 10065.
Katerina Dodelzon, MD
Department of Radiology, Weill Cornell Medicine at New York-Presbyterian Hospital, 525 E 68th St, New York, NY 10065.

Notes

Address correspondence to M. B. Reichman ([email protected], @MReichmanMD).
Version of record: Aug 16, 2023
The authors declare that there are no disclosures relevant to the subject matter of this article.

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