Anticoagulants, Aspirin Influence Colorectal Cancer Screening Results

Regular use of aspirin and direct-acting oral anticoagulants (DOACs) can interfere with fecal immunochemical tests (FIT) for colorectal cancer (CRC), increasing the risk of false positives, according to a study published in Gastroenterology.

Researchers conducted a cross-sectional study in an ongoing CRC screening trial in Norway. They included 4,908 patients 50 to 74 years with a positive result from a FIT (defined as >15 μg hemoglobin/g feces) who underwent subsequent colonoscopy. They categorized patients as “users” who regularly used aspirin (n=1,008), warfarin (n=147), or DOACs (n=212). These patients were matched to non-users (n=3,541) based on age, sex, screening center, and screening round.

During the study, CRC was diagnosed in 234 individuals and advanced adenomas were diagnosed in 1,305 individuals. The positive predictive value (PPV) for CRC was 3.8% for aspirin users compared with 6.4% for matched non-users (P=0.006). The PPV for advanced adenoma was 27.2% and 32.6%, respectively (P=0.011).

The PPV for CRC was 0.9% in DOAC users versus 6.8% in matched non-users (P=0.001). The PPV for advanced adenoma was 20.5% and 32.4%, respectively (P=0.002).

There was no significant difference in PPVs for CRC or advanced adenoma in warfarin users compared to non-users.

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Source: Gastroenterology