The Management of Antithrombotic Therapy in Image-Guided Breast Biopsy: A Systematic Review With Meta-Analysis

OBJECTIVE: Antithrombotic therapy (AT) is crucial for preventing life-threatening thromboembolic events (TEEs). However, concerns about bleeding events (BEs) often lead to AT discontinuation before image-guided breast biopsy (iBB). This systematic review and meta-analysis assess the necessity and safety of AT suspension prior to iBB.

METHODS: A systematic review was conducted using Embase and PubMed/MEDLINE databases through July 2024. Studies evaluating BEs in patients who had AT and were undergoing iBB were included. Case reports, surveys, and nonretrievable full texts were excluded. Data analysis was performed using Review Manager v5.4. The risk-of-bias assessment was based on the Risk Of Bias in Non-randomized Studies of Interventions tool.

RESULTS: Of the 216 studies screened, 8 met the inclusion criteria, which comprised 1154 patients undergoing AT and 10 370 controls. Bleeding events occurred in 203 (17.9%) patients with AT and 1110 (10.7%) controls, yielding a pooled odds ratio of 1.89 (Z = 5.23; P < 0.001). Heterogeneity was moderate (I² = 34%). Variability existed in AT drugs, iBB techniques, and definitions of "clinically relevant BE." Only 3 (0.23%) BEs were considered "clinically relevant" in 1 study.

CONCLUSION: Although current evidence is burdened by unstandardized reporting and data fragmentation, it supports the safety of performing iBB without suspending ongoing AT because local BEs, although slightly more frequent under AT, are predominantly minor and clinically irrelevant. Antithrombotic therapy continuation can improve diagnostic efficiency, minimize delays, limit patient anxiety, and reduce health care costs. Our quantitative findings support AT continuation in the context of iBB while providing a clinical rationale that addresses the TEE risks associated with AT interruption-an issue often underrepresented in prior literature.