Do You Need to Stop Your Anticoagulant Before a Biopsy?

Doctors frequently advise people to stop taking certain medicines prior to surgery or an invasive intervention like a biopsy. Anticoagulant drugs are especially likely to trigger such a warning, since they could lead to bleeding that might become hard to control. This puts the patient in a dilemma, though. The anticoagulant was prescribed for a reason. Is it safe to stop it before a biopsy, or might that lead to a hazardous blood clot? This is precisely the question one reader posed:

Is It Safe to Stop Pradaxa Before a Biopsy?

Q. My husband has been taking Pradaxa for four years. Now he needs a prostate biopsy. The doctor wants him to stop taking the drug for three days before the procedure and two or three days afterwards. Is this safe?

A. Dabigatran (Pradaxa) is an oral anticoagulant medication. It is prescribed to keep blood from clotting and causing trouble in certain situations: to prevent or treat a blood clot in the legs (deep vein thrombosis or DVT) and to treat non-valvular atrial fibrillation or a-fib.

Because the point of this medication is to prevent clotting, it can pose problems when someone needs surgery or a biopsy. Unless the medicine is stopped before a biopsy or operation, the biopsy could lead to excessive bleeding. That is why your husband’s doctor gave him a window of time in which he should not take the drug.

How Long Should He Wait?

There is a small risk that he could suffer a blood clot during that time, but presumably your husband’s doctor took that into account. Waiting a couple of days after the biopsy should allow time for healing and reduce the risk of hemorrhage.

Don’t let your husband forget to re-start the medication once the procedure is completed, and stay alert for symptoms of excessive bleeding once he is back on the medicine. Fortunately, there is an antidote to Pradaxa that can reverse hemorrhage in an emergency.