According to a manuscript published in the American Journal of Roentgenology (AJR), frequencies of imaging-apparent and palpable hematoma were not significantly different between patients temporarily discontinuing versus maintaining antithrombotic therapy (AT).

“The findings support safety of continuing AT during breast core-needle biopsy (CNB),” writes lead researcher Melissa Reichman, MD, a board-certified radiologist at Weill Cornell Medicine at New York-Presbyterian Hospital and lead researcher, adding that patients who maintain AT should be counseled regarding risk of bruise.

This AJR-accepted manuscript included 5,302 patients (median age, 52 years) who underwent image-guided breast or axillary CNB between Jan. 1, 2014, and Dec. 31, 2019. From Jan. 1, 2014, to Dec. 31, 2016, patients temporarily discontinued all AT for 5 days before CNB; from Jan.1, 2017 to Dec. 31, 2019, the cohort maintained AT during CNB. 

After reviewing immediate post-biopsy mammograms for apparent hematoma, patients were then called 24-48 hours post-procedure and asked about palpable hematoma and breast bruise. Reichman and her colleagues then reviewed medical records for clinically significant post-biopsy hematoma: hematoma requiring drainage, primary care or emergency department visit for persistent symptoms, or hospital admission. Finally, bleeding events were compared among groups.

Ultimately, 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, and patients maintaining AT, respectively, during breast CNB. The authors also reported that no patient developed clinically significant hematoma after biopsy.

Noting their findings “support the overall safety of maintaining AT during breast CNB,” Reichman and her colleagues conclude that developing concomitant institutional policies and professional guidelines should be considered, too.

Featured image: Left craniocaudal mammographic view obtained before (A) and after (B) biopsy show hematoma on postbiopsy image (arrow), measuring 1.2 cm.