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Gastroenterology. 2019 Jan 25. pii: S0016-5085(19)30103-9. doi: 10.1053/j.gastro.2019.01.040. [Epub ahead of print]

Effects of Oral Anticoagulants and Aspirin on Performance of Fecal Immunochemical Tests in Colorectal Cancer Screening.

Author information

1
Department of Research and Development, Telemark Hospital, Skien, Norway; Department of Bowel Cancer Screening, Cancer Registry of Norway, Oslo, Norway; Institute of Clinical Medicine, University of Oslo, Norway; Department of Medicine, Ostfold Hospital Trust, Grålum, Norway. Electronic address: Kristin.Ranheim.Randel@cancerregistry.no.
2
Researcher, Department of Bowel Cancer Screening, Cancer Registry of Norway, Oslo, Norway; Norwegian National Advisory Unit for Women's Health, Women's Clinic, Oslo University Hospital, Oslo, Norway.
3
Department of Medicine, Ostfold Hospital Trust, Grålum, Norway; Institute of Clinical Medicine, University of Oslo, Norway.
4
Department of Medicine, Vestre Viken Bærum Hospital, Gjettum, Norway; Institute of Clinical Medicine, University of Oslo, Norway.
5
Professor, Clinical Effectiveness Research Group, Institute of Health and Society, University of Oslo, Norway; President, Frontier Science Foundation, Boston, Massachusetts, United States; Department of Transplantation Medicine, Oslo University Hospital, Oslo, Norway.
6
Deputy Head, Department of Research and Development, Telemark Hospital, Skien, Norway; Researcher, Department of Bowel Cancer Screening, Cancer Registry of Norway, Oslo, Norway; Professor emeritus, Institute of Clinical Medicine, University of Oslo, Norway.
7
Associate professor, Institute of Clinical Medicine, University of Oslo, Norway; Department of Transplantation Medicine, Oslo University Hospital, Oslo, Norway.
8
Head, Department of Bowel Cancer Screening, Cancer Registry of Norway, Oslo, Norway; Department of Transplantation Medicine, Oslo University Hospital, Oslo, Norway; Department of Medicine, Sorlandet Hospital Kristiansand, Kristiansand, Norway.

Abstract

BACKGROUND & AIMS:

The fecal immunochemical test (FIT) is the tool most frequently used for colorectal cancer (CRC) screening worldwide. It is unclear how the use of aspirin and oral anticoagulants in the screening population affect the diagnostic performance of FIT.

METHODS:

We performed a cross-sectional study in an ongoing CRC screening trial in Norway. Participants 50-74 years old with a positive result from a FIT (>15μg hemoglobin/g feces) and subsequent colonoscopy (reference standard) were included. Those who used regular aspirin, warfarin, or direct-acting oral anticoagulants (DOACs) were defined as users. Non-users were matched according to age, sex, screening center, and screening round. The primary outcomes were the positive predictive value (PPV) for CRC and advanced adenoma.

RESULTS:

Among 4908 eligible participants, 1008 used aspirin, 147 used warfarin, 212 used DOACs, and 3541 were non-users. CRCs were found in 234 individuals and advanced adenomas in 1305 individuals. The PPV for CRC was 3.8% for aspirin users vs 6.4% for matched non-users (P=.006); the PPV for advanced adenoma in aspirin users was 27.2% vs 32.6% for matched non-users (P=.011). For DOAC the PPV for CRC was 0.9% in users vs 6.8% in matched non-users (P=.001); the PPV for advanced adenoma in DOAC users was 20.5% vs 32.4 % in matched non-users (P=.002). There was no significant difference in PPVs for CRC or advanced adenoma in warfarin users compared to non-users.

CONCLUSIONS:

In a large screening cohort in Norway, regular use of aspirin, and particularly DOAC, were associated with lower PPV of FIT for detection of CRCs and advanced adenomas. ClinicalTrials.gov no: NCT01538550.

KEYWORDS:

acetyl salicylic acid; colorectal neoplasia; immunochemical fecal occult blood test

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