Effect of Aspirin and Antiplatelet Drugs on the Outcome of the Fecal Immunochemical Test

• Published in: Mayo Clinic proceedings Vol. 88; no. 7; pp. 683 - 689
• Main Authors: Bujanda, Luis, MD, PhD, Lanas, Ángel, MD, PhD, Quintero, Enrique, MD, PhD, Castells, Antoni, MD, PhD, Sarasqueta, Cristina, MD, Cubiella, Joaquín, MD, PhD, Hernandez, Vicent, MD, PhD, Morillas, Juan D., MD, PhD, Perez-Fernández, Teresa, MD, Salas, Dolores, MD, Andreu, Montserrat, MD, PhD, Carballo, Fernando, MD, PhD, Bessa, Xavier, MD, PhD, Cosme, Angel, MD, PhD, Jover, Rodrigo, MD, PhD
• Format: Journal Article
• Language: English
• Published: England Elsevier Inc 01.07.2013; Elsevier, Inc; Elsevier Limited
• Subjects: Aged; Aggregation; Anti-Inflammatory Agents, Non-Steroidal - therapeutic use; Aspirin; Aspirin - therapeutic use; Blood platelets; Cancer; Clinical trials; Colorectal Neoplasms - diagnosis; Colorectal Neoplasms - epidemiology; Colorectal Neoplasms - prevention & control; Diagnosis; Female; Health aspects; Humans; Immune system; Immunochemistry - methods; Internal Medicine; Male; Management; Mass Screening - statistics & numerical data; Middle Aged; Occult Blood; Outcome Assessment (Health Care); Platelet Aggregation Inhibitors - therapeutic use; Reproducibility of Results; Risk Factors; Testing; AA; positive predictive value; advanced neoplasia; colorectal cancer; advanced adenoma; fecal immunochemical test; AN; dual antiplatelet therapy; FIT; nonaspirin antiplatelet agent; nonadvanced neoplasia; CRC; NAAA; PPV; NAN; DAPT
• ISSN: 0025-6196; 1942-5546
• DOI: 10.1016/j.mayocp.2013.04.016

Abstract Objective To evaluate the effect of aspirin and nonaspirin antiplatelet agents (NAAAs) on the performance of the fecal immunochemical test (FIT). Participants and Methods We performed a post hoc analysis of results from a clinical trial that involved 28,696 asymptomatic average-risk men and women aged 50 to 69 years invited to participate in a colorectal cancer screening program with FIT between November 1, 2008, and June 31, 2011. Results The test was returned by 6390 individuals (22.3%), of whom 5821 (91.1%) reported not using antiplatelet drugs (nonusers group) and 569 (8.9%) reported using these drugs at the time of testing (users group). The FIT result was positive in 48 of 569 users (8.4%) and 365 of 5821 nonusers (6.3%) ( P =.05). A positive FIT result was found in 7.3% (28/384) of aspirin users, 7.1% (10/140) of NAAA users, and 22.2% (10/45) of those undergoing dual antiplatelet therapy (DAPT) (aspirin plus an NAAA). The DAPT subgroup had a significantly higher positive FIT rate than the nonuser group (odds ratio, 3.5; 95% CI, 1.7-7.3; P <.05). The positive predictive value (PPV) for advanced neoplasia (AN) in nonusers was 50.4% vs 50.0% in users ( P  = .40). The PPV for AN was 57.0% in aspirin users, 30.0% in NAAA users, and 50.0% in DAPT users, without statistically significant differences between the user and nonuser groups. Conclusion The use of DAPT increased the rate of positive FIT results. Use of aspirin, NAAAs, or both did not modify the PPV for AN in this population-based colorectal screening program. Trial Registration clinicaltrials.gov Identifier: NCT00906997