Anticoagulation and bone marrow biopsy: is it safe to proceed?

Area of Science:

• Hematology
• Clinical Procedures
• Patient Safety

Background:

• Bone marrow (BM) biopsy is a common hematologic diagnostic procedure.
• Bleeding risk in patients on anticoagulation for BM biopsy is not well-defined.
• Current guidelines lack robust data on managing anticoagulation during BM biopsy.

Purpose of the Study:

• To present evidence on managing anticoagulation for BM biopsy.
• To guide clinicians on optimal periprocedural anticoagulation strategies.

Main Methods:

• Systematic review of existing guidelines on anticoagulation management for BM biopsy.
• Summary of institutional practices for BM biopsy in anticoagulated patients.

Main Results:

• Significant hemorrhage post-BM biopsy is rare (0.007-1.1%).
• BM biopsy carries a low to moderate bleeding risk.
• Anticoagulation interruption is not consistently recommended; risk mitigation strategies are available.
• Myeloproliferative neoplasms can cause acquired von Willebrand syndrome, increasing bleeding risk.

Conclusions:

• Routine withholding of anticoagulation before BM biopsy is not recommended.
• Individualized assessment and optimization of bleeding risk factors are crucial for patient management.