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.

Douglas K. Rex, MD, FASGE

COMMENT
These results are likely to be interpreted differently by countries with varying resources for colonoscopy. In the U.S., my interpretation would be that the results would not mandate stopping anticoagulant or antiplatelet agents to perform FIT screening. Further, patients receiving anticoagulant or antiplatelet agents still warrant colonoscopy when they have a positive FIT.

Note to readers: At the time we reviewed this paper, its publisher noted that it was not in final form and that subsequent changes might be made.

CITATION(S)

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)