Anticoagulation and bone marrow biopsy: is it safe to proceed?

Figures & data

Table 1. Bleeding risk assessment and anticoagulation management recommendations for bone marrow biopsy

Guideline	Bleeding risk category	Recommendations
Thrombosis Canada: NOACs/DOACs preoperative management [15]	Moderate	Stop NOAC/DOAC one day prior to procedure.
Thrombosis Canada: Warfarin Perioperative Management [16]	Low/Moderate	Selected procedures with large-bore needles (e.g. bone marrow biopsy) may need Warfarin interruption. Stop warfarin five days before procedure and consider bridging for high-risk groups.
MD Anderson Periprocedure Management of Anticoagulants [17]	Low	Do not interrupt anticoagulation.
2016 Focused Update of the Canadian Cardiovascular Society Guidelines for the Management of Atrial Fibrillation [18]	Low	Low risk procedures are generally safe to perform without interrupting antithrombotic therapy, provided the INR is not supratherapeutic in the case of warfarin.
Society of Interventional Radiology Consensus Guidelines for the Periprocedural Management of Thrombotic and Bleeding Risk in Patients Undergoing Percutaneous Image-Guided Interventions –Part II: Recommendations [19]	Low	Do not withhold anticoagulation. Target INR </ = 3.0. Consider bridging for high thrombosis risk cases. Exception: Withhold glycoprotein IIb/IIIa inhibitors 4–8 h before procedure.
The manuals from the Canterbury District Health Board - Protocol for Bone Marrow Aspirate and Trephine Biopsy [12]	Not specified	Warfarin interruption not required.
Bleeding risk assessment for bedside and interventional radiology guided procedures: Consensus guidelines and beyond [20]	BM aspiration without biopsy is low risk. BM biopsy is moderate to high risk	Stop DOAC one to two days prior to the procedure. Target INR <1.8 for high risk procedures.

Abbreviations: BM, bone marrow; DOAC, direct oral anticoagulant; INR, international normalized ratio; NOAC, novel oral anticoagulant.

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