Anticoagulant and Antiplatelet Agents Affect Fecal Immunochemical Test Performance
Douglas K. Rex, MD, MASGE, reviewing Rasmussen SL, et al. Endoscopy 2023 Jan 26.
In a very large study, 11.8% of 77,007 patients receiving antithrombotic treatment had a positive fecal immunochemical test (FIT) result, compared with 6% of those receiving no treatment. The relative risk of a positive FIT was increased with every class of agents, including aspirin (1.22), warfarin (1.60), direct oral acting anticoagulant (DOAC; 2.40), antiplatelet therapy (1.18), warfarin plus antiplatelet therapy (2.14), dual antiplatelet therapy (1.34), and triple therapy (any 3 drugs; 2.36).
The positive predictive value (PPV) for cancer was 6.4% in patients not receiving antithrombotic treatment. The PPV for cancer was reduced by 60% in patients taking DOACs and 64% in patients receiving triple therapy, but there was some reduction across the board of anticoagulants. The absolute risk rates of cancer with a positive FIT for patients receiving DOACs and triple therapy were 3.3% and 3.0%, respectively. The risk of cancer or any high-risk adenoma in FIT-positive patients was also reduced, with the greatest reduction of 42% in patients receiving DOACs.
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Rasmussen SL, Torp-Pedersen C, Gotschalck KA, Thorlacius-Ussing O. The effect of antithrombotic treatment on the fecal immunochemical test for colorectal cancer screening: a nationwide cross-sectional study. Endoscopy 2023 Jan 26. (Epub ahead of print) (https://doi.org/10.1055/a-1992-5598)