Brown Theodore, Schafer Leah, Qureshi Muhammad Mustafa, Freer Phoebe, Niell Bethany L, Yeh Eren D, Moy Linda, Fishman Michael D C, Slanetz Priscilla J
Boston University Medical Center, Department of Radiology, Boston, MA, USA.
New Zealand Pacific Radiology Group, Wellington, New Zealand.
J Breast Imaging. 2023 Jun 26;5(4):445-452. doi: 10.1093/jbi/wbad040. eCollection 2023 Jul-Aug.
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.
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.
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 ( = 0.08). Withholding of medications did not vary by lesion location (182/308, 59%, breast vs 181/308, 58.7%, axillary; = 0.81). Respondents were statistically more likely to withhold medications if using a vacuum-assisted device for all classes of antithrombotic medications ( < 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.
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.
鉴于在抗血栓药物治疗患者的管理方式上存在差异，我们开展了这项研究，以了解接受经皮乳房和腋窝手术患者的抗血栓管理现状。
2021年3月，一份包含多项选择题和书面回答选项的20项调查问卷通过电子邮件发送给北美乳腺影像学会（SBI）的2094名活跃会员。数据以匿名方式收集并进行定量分析，自由文本回复按主题分类。
2094名会员中有326名（15.6%）完成了调查。87%（274/313）报告有抗血栓药物管理政策。59%（185/312）报告在活检前常规停用药物，在东北部和南部更为常见（P = 0.08）。药物停用情况不因病变部位而异（乳房病变为182/308，59%；腋窝病变为181/308，58.7%；P = 0.81）。对于所有类别的抗血栓药物，如果使用真空辅助装置，受访者在统计学上更有可能停用药物（P < 0.001）。服用华法林的患者中高达50.2%（100/199）以及服用直接口服抗凝剂的患者中33.6%（66/196）的药物停用比指南建议更为严格。
基于对SBI会员的调查，在影像引导下的乳房和腋窝手术的抗血栓管理方面，乳腺影像实践差异很大。在停用抗血栓药物的60%的人中，少数人遵循推荐的停用指南，这使至少一些患者面临血栓形成事件的潜在风险。乳腺影像放射科医生应权衡停用这些药物的风险和益处，如果选择停用，应严格遵循循证指南以尽量降低这种做法的风险。
