Core Needle Breast Biopsy Safe In Patients on Anticoagulation Therapy

Core needle biopsy is a preferred method for evaluating suspicious mammogram results. New research indicates that the procedure is safe, even in those patients undergoing anticoagulation therapy. “An every day part of our practice is the core biopsy patient,” says lead author Patricia Somerville, MD, a radiologist at the Elizabeth Wende Breast Clinic in Rochester, New York. “We service a big geographic area with a large number of elderly people who are on anticoagulant therapies.”

This, she notes, results in two problems. Many patients cannot stop taking their anticoagulant medication to have a biopsy; and others live far away and are reluctant to return later, after they have stopped their medications. Dr. Somerville decided to conduct a retrospective study to determine whether it was safe to perform core needle biopsies in patients who continued on anticoagulation therapy.

Dr. Somerville and colleagues reviewed the cases of 1,055 women who underwent a core needle biopsy from August 2004-May 2007. Of these, 200 women (encompassing 220 biopsy sites) had been taking some form of anticoagulation therapy daily: 180 received aspirin, 16 were on warfarin, and 4 took Excedrin. The remaining 855 women (encompassing 924 biopsy sites) made up the control group and had not received blood-thinning medications. Dr. Somerville noted that the number of patients in the study who were taking clopidogrel bisulfate (Plavix) was not meaningful. She suggested further study to assess the risk of bleeding in patients on this anticoagulation regimen.

A significantly greater percentage of patients in the anticoagulant group experienced more extensive bruising compared with patients in the control group (34% vs 26.5%; P = .035). The study found no statistically significant differences between the two cohorts in hematoma formation or bruising with hematoma. None of the patients who underwent core needle biopsy reported any clinically important complications, such as bleeding episodes that required hospitalization or operative interventions. Nor were there any recorded instances in which the bruising affected treatment decisions.

“The incidence of severe bleeding complications were the same, we had no significant bleeding in either group,” says Dr. Somerville. “Patients on anticoagulation did have more bruising, which was not unexpected. The bruising resolved in a few weeks and did not interfere with any other diagnosis or treatment.”

Results of this study contraindicate previous concerns about the possibility of patients on anticoagulant therapy bleeding excessively during a core needle biopsy. A growing number of patients have conditions that require anticoagulant medications, and this increases the options readily available to them for breast biopsy.

“Many physicians would make their patients go off of anticoagulation therapy prior to having a core biopsy and it just is not necessary,” Dr. Somerville says. “There is no reason to expose patients to the added risks of surgical biopsies or discontinuation of therapy.”

Despite the results of this study, David Dershaw, MD, director of the breast imaging section of the Department of Radiology at Memorial Sloan-Kettering Cancer Center in New York City says his perspective on the use of needle biopsies in women on anticoagulants has not changed.

“I feel that needle breast biopsies are not an emergent procedure and if a patient has a risk factor that can be corrected before the procedure, it is appropriate to do so,” he says. “I do not think that this study indicates that you should proceed without correcting compromised coagulation. Instead, it says that if it is not safe to correct this risk factor for bleeding, it is appropriate to proceed even in the setting of anticoagulation.”

Dr. Dershaw’s clinical experience also suggests that although the study’s patients on anticoagulants did not report a greater incidence of hematoma, they often experience an oozing phenomenon. Achieving satisfactory hemostatis in those patients may take longer.

Somerville P, Seifert PJ, Destounis SV, et al. Anticoagulation and bleeding risk after core needle biopsy. AJR. 2008;191(4):1194-1197.

About the author: Kurt Ullman is a freelance health and medical writer based out of Indianapolis.