Purpose: Percutaneous core biopsy of suspicious breast or axillary findings plays an essential diagnostic role in the patient management. However, in the absence of societal or national guidelines, there is variability in how practices manage patients on antithrombotic medications. Performing such procedures on patients taking anticoagulants poses increased risk for bleeding, whereas withholding such medications poses serious risks of thrombotic events. Therefore, we undertook this study to better understand the current practice of anticoagulation management for patients undergoing percutaneous breast procedures in North America.
Materials and Methods: This survey study was deemed exempt by the Institutional Review Board. A 20-item survey with multiple choice and write-in options was emailed to 2094 members of the Society of Breast Imaging on March 25th, 2021 with a reminder emailed two weeks later. Data was collected anonymously using SurveyMonkey (San Mateo, CA). Data was analyzed quantitatively and open responses categorized by themes.
Results: 322 completed surveys were received yielding a response rate of 15.4%. Of respondents who answered, 64% (200/311) reported that their practice had a policy for managing antithrombotics at divisional level and 23% at the departmental level, whereas 10% reported that there was no policy at their practice at any level. 59% (183/310) reported routinely withholding antithrombotics in the periprocedural period, and of those, 98% (172/176) did so for patients taking warfarin, 96% (169/176) for direct oral anticoagulant (DOAC), and 63% (111/176) for aspirin/NSAIDs. Of those that decided to withhold warfarin, there was no consensus for target International Normalized Ratio (INR), with 27% (50/185) using target INR < 1.5, 27% with INR <2, and 12% INR <2.5. It was approximately 10% more likely that antithrombotics of all classes were withheld if a patient was scheduled to undergo vacuum-assisted core needle biopsy rather than a spring-loaded biopsy. Of respondents, 78% (223/287) did not change their management of antithrombotics for vacuum assisted biopsy versus spring-loaded biopsy. The percentage of respondents who chose to withhold anticoagulation for an axillary versus breast biopsy were 58% (178/307) and 59% (181/31) respectively.
Conclusion: Based on this survey of SBI members, practices vary widely in the management of anticoagulated patients presenting for image-guided breast and axillary procedures. Therefore, there is a need to develop societal or national guidelines in order to promote safe and high quality care.
Clinical Relevance Statement: Management of anticoagulation in patients undergoing percutaneous breast procedures varies greatly among practices suggesting that development of national guidelines is indicated.
