Bleeding Complications after Breast Biopsies in Patients on Anticoagulation: Comparison of Maintaining versus Discontinuing Anticoagulants Prior to Biopsy

Purpose: : Image-guided core needle biopsy (CNB) is the standard procedure for breast lesions requiring tissue diagnosis. Although rare, the most common complication is bleeding, a risk which may be elevated for patients taking anticoagulants. Despite studies suggesting that it is safe to continue anticoagulation during CNB, current American College of Radiology (ACR) guidelines recommend patients stop their medication on a case-by-case basis. This may put patients at unnecessary risk for thromboembolic events. The purpose of this study was to compare post-CNB bleeding complications for patients who continue anticoagulation versus those who cease anticoagulation prior to CNB.

Materials and Methods: This HIPPA compliant IRB approved retrospective study queried the institutional radiology database for all patients on and off anticoagulation undergoing CNB at our institution 2-years before and 2-years after institutional policy no longer requiring cessation of anticoagulation prior to biopsy. The study cohort included 1,969 patients of whom 57 (2.9%) stopped anticoagulation prior to CNB while 198 (10%) continued anticoagulation at the time of CNB. Demographic information, risk factors, core needle pathology, anticoagulation type and history were collected from the electronic chart. Post-biopsy mammograms were retrospectively reviewed for hematoma formation and the medical chart was reviewed for patient symptoms of bruising and hematoma. Firth’s bias reduced logistic regression was used to evaluate the association between continuing the use of anticoagulants during breast biopsy and hematoma.

Results: Although patients on anticoagulation during CNB were at increased relative risk of hematoma formation compared to those not being treated with anticoagulation (2.24 [95% CI: 1.45, 3.78]), no statistically significant increased risk of hematoma formation was noted for patients on anticoagulants at the time of biopsy versus those who temporarily stopped anticoagulation prior to biopsy (OR: 0.74; 95% CI: 0.22 to 1.99; p = 0.55). Overall, clinical symptoms of hematoma formation were infrequent among all groups [not on anticoagulation 2.3%, on anticoagulation but stopped 3.6%, on anticoagulation during CNB 4.5%], and not statistically different among those on and those not on anticoagulation (p=0.12). Bruising, although still infrequent, was more commonly reported in patients who continued anticoalition at the time of biopsy compared to those who stopped (p=0.008).

Conclusion: No statistically significant increased risk of bleeding for patients continuing anticoagulation during CNB. Overall, clinical symptoms and rates of hematoma formation for patients on anticoagulation are low, suggesting low morbidity from CNBs.

Clinical Relevance Statement: The results of the study support the safety of the practice of continuing anticoagulation during CNB.