Breast biopsy management in patients under anticoagulation or antiplatelet therapy – results from a German Expert Survey

Background Pretherapeutic histologic diagnosis through image-guided core needle biopsy (CNB) or vacuum-assisted biopsy (VAB) of suspicious breast findings has become a standard procedure. Despite the moderate bleeding risk a relevant proportion of patients are under temporary or permanent anticoagulation (ACT) or antiplatelet therapy (APT) due to relevant pre-existing medical conditions. Up to now there are no standards for the management of breast biopsies in these patients. Thus, managing these patients varies in clinical routine.

Methods An online survey was conducted among all members of the breast ultrasound working group of the German Society for Ultrasound in Medicine (DEGUM) and the working group for breast diagnostics of the German Radiology Society (DRG) including n=51 questions about the individual risk perception for biopsy-related bleeding complications in general as well as specific management of biopsies under ACT/APT.

Results In total n=332 experts participated. More than half of all participants do not have a standardized management for breast biopsies in patients under ACT/APT (51.8 %). Concerning specific ACT/APT medications the survey reveals discrepancies in risk perception and management: Except of patients under acetylsalicylic acid (ASA) and prophylactic heparin the majority prefers discontinuing medication with DOAC (directly acting oral anticoagulants), Phenprocoumon and therapeutic heparin before performing CNB or VAB.

Conclusion Breast biopsies in patients on medication with ASA and prophylactic heparin are regarded as safe procedures and are performed in clinical routine in Germany. Nonetheless, performing breast biopsies under other ACT/APT like DOAC or Phenprocoumon seems to be feasible only for a minority of experts.

Publication History

Article published online:
21 June 2022