Current Practices in Anticoagulation Management for Patients Undergoing Percutaneous Image-guided Breast Procedures

Theodore Brown; Leah Schafer; Muhammad Mustafa Qureshi; Phoebe Freer; Bethany L Niell; Eren D Yeh; Linda Moy; Michael D C Fishman; Priscilla J Slanetz

doi:10.1093/jbi/wbad040

Current Practices in Anticoagulation Management for Patients Undergoing Percutaneous Image-guided Breast Procedures

J Breast Imaging. 2023 Jun 26;5(4):445-452. doi: 10.1093/jbi/wbad040. eCollection 2023 Jul-Aug.

Authors

Theodore Brown¹, Leah Schafer², Muhammad Mustafa Qureshi³, Phoebe Freer⁴, Bethany L Niell⁵, Eren D Yeh⁶, Linda Moy⁷, Michael D C Fishman¹, Priscilla J Slanetz¹

Affiliations

¹ Boston University Medical Center, Department of Radiology, Boston, MA, USA.
² New Zealand Pacific Radiology Group, Wellington, New Zealand.
³ Boston University Medical Center, Department of Radiation Oncology, Boston, MA, USA.
⁴ University of Utah, Department of Radiology, Salt Lake City, UT, USA.
⁵ H. Lee Moffitt Cancer Center and Research Institute, Department of Oncologic Sciences, Tampa, FL, USA.
⁶ Brigham and Women's Hospital, Department of Radiology, Boston, MA, USA.
⁷ NYU Grossman School of Medicine, Laura and Isaac Perlmutter Cancer Center, New York, NY, USA.

PMID: 37520156
PMCID: PMC10380696 (available on 2024-06-26)
DOI: 10.1093/jbi/wbad040

Abstract

Objective: Given variability in how practices manage patients on antithrombotic medications, we undertook this study to understand the current practice of antithrombotic management for patients undergoing percutaneous breast and axillary procedures.

Methods: A 20-item survey with multiple-choice and write-in options was emailed to 2094 active North American members of the Society of Breast Imaging (SBI) in March 2021. Data were collected anonymously and analyzed quantitatively, with free-text responses categorized by themes.

Results: Three-hundred twenty-six of 2094 members (15.6%) completed the survey. Eighty-seven percent (274/313) reported having a policy for managing antithrombotic medications. Fifty-nine percent (185/312) reported routinely withholding medications before biopsy, more commonly in the Northeast and South (P = 0.08). Withholding of medications did not vary by lesion location (182/308, 59%, breast vs 181/308, 58.7%, axillary; P = 0.81). Respondents were statistically more likely to withhold medications if using a vacuum-assisted device for all classes of antithrombotic medications (P < 0.001). Up to 50.2% (100/199) on warfarin and 33.6% (66/196) on direct oral anticoagulants had medications withheld more stringently than guidelines suggest.

Conclusion: Based on a survey of SBI members, breast imaging practices vary widely in antithrombotic management for image-guided breast and axillary procedures. Of the 60% who withhold antithrombotic medications, a minority comply with recommended withhold guidelines, placing at least some patients at potential risk for thrombotic events. Breast imaging radiologists should weigh the risks and benefits of withholding these medications, and if they elect to withhold should closely follow evidence-based guidelines to minimize the risks of this practice.

Keywords: anticoagulation; benign breast disease; breast biopsy; breast cancer; breast intervention.