Bone Marrow Biopsy in Patients on Dual Antiplatelet Therapy

Management Recommendations for Patients on DAPT

The European Society of Cardiology recommends continuing aspirin therapy during bone marrow biopsy as the risk of thrombotic events from discontinuation outweighs the bleeding risk 1
The European Society of Cardiology suggests that aspirin discontinuation should only be considered for ultra-high risk procedures, which bone marrow biopsy is not typically classified as 2
For elective bone marrow biopsy, the European Society of Cardiology recommends considering withholding P2Y12 receptor inhibitor (clopidogrel, ticagrelor, prasugrel) 5 days before the procedure while continuing aspirin 2
For urgent bone marrow biopsies where P2Y12 inhibitor cannot be discontinued, the European Society of Cardiology recommends proceeding with caution and implementing additional hemostatic measures 1
The European Society of Cardiology advises resuming P2Y12 inhibitor once adequate hemostasis has been achieved 2
For patients with recent coronary stent placement (within 1 month), the European Heart Society recommends deferring elective bone marrow biopsy if possible 3, 4
If bone marrow biopsy cannot be deferred in high thrombotic risk patients (e.g., recent stent placement), the European Heart Society suggests considering consultation with a multidisciplinary team including cardiology 3, 4
The European Society of Cardiology recommends never discontinuing both antiplatelet agents simultaneously due to high risk of stent thrombosis 2

The European Society of Cardiology recommends using radial approach when possible to minimize bleeding risk 6

The European Society of Cardiology advises resuming P2Y12 inhibitor as soon as adequate hemostasis is confirmed after bone marrow biopsy 2