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

Background: Antithrombic therapy (AT) is commonly temporarily discontinued before breast core-needle biopsy (CNB), introducing risks of thrombotic events and diagnostic delay. Objective: To compare the frequency of postbiopsy bleeding events between patients without AT use, patients temporarily discontinuing AT, and patients maintaining AT, 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 for 5 days before CNB; from January 1, 2017 to December 31, 2019, patients maintained AT during CNB. Immediate postbiosy mammograms were reviewed for imaging-apparent hematoma. Patients were called 24-48 hours after biopsy and asked regarding palpable hematoma and breast bruise. 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's bias-reduced multivariable logistic regression analysis. Results: During CNB, 4665 patients were not receiving AT, 423 temporarily discontinued AT, and 214 maintained AT. Imaging-apparent hematoma occurred in 3% of patients without AT use, 6% of patients discontinuing AT, and 7% of patients maintaining AT [p=.60 (discontinuing vs maintaining)]. Palpable hematoma occurred in 2% of patients without AT use, 4% of patients maintaining AT, and 4% of patients continuing AT [p=.92 (discontinuing vs maintaining)]. Breast bruise occurred in 2% of patients without AT use, 1% of patients discontinuing AT, and 6% of patients maintaining AT [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 (using maintained AT 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. Clinical Impact: The findings support safety of continuing AT during CNB. Patients who maintain AT should be counseled regarding risk of bruise.