Isolated spontaneous breast haemorrhage in a patient on anticoagulation therapy: Breast biopsy or not?

A 62-year-old woman presented with a hard, well circumscribed, painless breast lump of 2 weeks duration. Past history showed an episode of deep vein thrombosis 6 weeks earlier, for which she was on warfarin. Mammogram, ultrasound and needle biopsy confirmed spontaneous haemorrhagic necrosis of breast tissue, a rare site for spontaneous bleeding for patients on anticoagulants. Though concurrent use of warfarin or heparin is generally considered a contraindication to carrying out core breast biopsy, recent evidence suggests it is unnecessary to discontinue anticoagulants in patients undergoing such procedures, which is crucial in ruling out incidental malignancy, especially in elderly patients.