Antithrombotic Therapy and Hematoma Risk during Image-guided Core-Needle Breast Biopsy

Area of Science:

• Radiology
• Oncology
• Cardiology

Background:

• Uncertainty exists regarding the necessity of withholding antithrombotic medication before core-needle breast biopsy (CNBB) due to hematoma risks.
• This study addresses the hematoma risk associated with antithrombotic use during CNBB.

Purpose of the Study:

• To evaluate the risk of hematoma formation after CNBB in patients taking antithrombotic medications.
• To stratify this risk based on the specific type of antithrombotic medication used.

Main Methods:

• A retrospective study involving 3311 CNBBs (US, stereotactic, MRI-guided) across 12 practices.
• Patients were divided into antithrombotic and nonantithrombotic groups, with instructions to continue medications.
• Hematomas were defined as new masses ≥2 cm on mammography; clinically significant hematomas required intervention beyond compression.

Main Results:

• The overall hematoma rate was higher in the antithrombotic group (9.4%) compared to the nonantithrombotic group (6.2%) (P = .007).
• However, clinically significant hematoma rates were similar and low in both groups (0.4% vs. 0.04%; P = .07).
• Multivariable analysis identified older age, 9-gauge or larger needles, and full-dose antiplatelet drugs as risk factors for hematomas. Ultrasound guidance and 10-14-gauge needles were associated with lower risk.

Conclusions:

• Clinically significant hematomas are uncommon following CNBB, suggesting that withholding antithrombotic medications may not be necessary.
• Full-dose antiplatelet drugs, patient age, and use of larger needles (≥9-gauge) are associated with increased hematoma risk.
• No significant association was found between other antithrombotic medication types and hematoma risk.