Effect of anticoagulants and NSAIDs on accuracy of faecal immunochemical tests (FITs) in colorectal cancer screening: a systematic review and meta-analysis

Nieuwenburg, Stella A.; Vuik, Fanny E.; Kruip, Marieke J.H.A.; Kuipers, Ernst J.; Spaander, Manon C.W.

doi:10.1136/gutjnl-2018-316344

Cited by 32 publications

(25 citation statements)

References 36 publications

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“…A recent meta-analysis of six original papers involving FIT-positive patients reported that aspirin and OACs do not affect the PPV of FITs for detecting ACRN [10]. However, a meta-analysis for CRC was not performed in this study because most previous studies on this topic only presented results for ACRN and not for CRC.…”

Section: Discussionmentioning

confidence: 89%

Use of Antiplatelet Agents Decreases the Positive Predictive Value of Fecal Immunochemical Tests for Colorectal Cancer but Does Not Affect Their Sensitivity

Jung

Lee

et al. 2021

JPM

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Previous studies have evaluated the effects of antithrombotic agents on the performance of fecal immunochemical tests (FITs) for the detection of colorectal cancer (CRC), but the results were inconsistent and based on small sample sizes. We studied this topic using a large-scale population-based database. Using the Korean National Cancer Screening Program Database, we compared the performance of FITs for CRC detection between users and non-users of antiplatelet agents and warfarin. Non-users were matched according to age and sex. Among 5,426,469 eligible participants, 768,733 used antiplatelet agents (mono/dual/triple therapy, n = 701,683/63,211/3839), and 19,569 used warfarin, while 4,638,167 were non-users. Among antiplatelet agents, aspirin, clopidogrel, and cilostazol ranked first, second, and third, respectively, in terms of prescription rates. Users of antiplatelet agents (3.62% vs. 4.45%; relative risk (RR): 0.83; 95% confidence interval (CI): 0.78–0.88), aspirin (3.66% vs. 4.13%; RR: 0.90; 95% CI: 0.83–0.97), and clopidogrel (3.48% vs. 4.88%; RR: 0.72; 95% CI: 0.61–0.86) had lower positive predictive values (PPVs) for CRC detection than non-users. However, there were no significant differences in PPV between cilostazol vs. non-users and warfarin users vs. non-users. For PPV, the RR (users vs. non-users) for antiplatelet monotherapy was 0.86, while the RRs for dual and triple antiplatelet therapies (excluding cilostazol) were 0.67 and 0.22, respectively. For all antithrombotic agents, the sensitivity for CRC detection was not different between users and non-users. Use of antiplatelet agents, except cilostazol, may increase the false positives without improving the sensitivity of FITs for CRC detection.

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Section: Discussionmentioning

confidence: 89%

Use of Antiplatelet Agents Decreases the Positive Predictive Value of Fecal Immunochemical Tests for Colorectal Cancer but Does Not Affect Their Sensitivity

Jung

Lee

et al. 2021

JPM

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“…These antibodies are specific to human globin so, unlike the traditional gFOBT, they are not prone to interference from any haemoglobin derived from the diet or from any substance that interferes in the redox reaction of guaiac, such as peroxidases. Moreover, a recent systematic review has shown that cessation of oral anticoagulants, aspirin and other non-steroidal anti-inflammatory drugs is not required 22. There are a large number of FIT on the market; many of these are qualitative tests with very little evidence to support their use in any clinical setting.…”

Section: Analytical Considerationsmentioning

confidence: 99%

Setting up a service for a faecal immunochemical test for haemoglobin (FIT): a review of considerations, challenges and constraints

2018

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Quantitative faecal immunochemical tests for haemoglobin (FIT) have now been advocated by the National Institute for Care and Health Excellence (NICE: DG30) to assist in the triage of patients presenting with symptoms that suggest a low risk of colorectal (bowel) cancer. The evidence is that FIT provides a good rule out test for significant bowel disease. However, a small number of cases will be missed, and robust safety-netting procedures are required to follow up some FIT-negative patients. A range of diagnostic pathways are possible, and there is no best approach at present. Introduction of FIT requires careful consideration of the logistics of supply of devices and information to requesting sites and of transport to the laboratory. A number of FIT analytical systems are available. Three are documented as appropriate for use in assessment of patients with symptoms. However, preanalytical, analytical and postanalytical challenges remain. The methods have different specimen collection devices. The methods use polyclonal antibodies and there is no primary reference material or method to which FIT methods are standardised. Third-party internal quality control is lacking, and external quality assessment schemes have many difficulties in providing appropriate materials. Reporting of results should be done using µg Hb/g faeces units and with knowledge of the limit of detection and limit of quantitation of the analytical system used. FIT can be used successfully in an agreed diagnostic pathway, along with other clinical and laboratory information: this requires a multidisciplinary approach, providing opportunities for professionals in laboratory medicine involvement.

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“…Existing studies on aspirin use report mixed findings that merit further investigation [ 26 30 ]. The USPTF guidelines suggest routine prescribing of aspirin in patients presenting with advanced colorectal polyps unless contraindicated [ 9 ].…”

Section: Discussionmentioning

confidence: 99%

“…Other evidence suggests that aspirin may impact on FIT performance. Studies have reported either a potential higher risk of false positive FIT results, no changes in FIT diagnostic accuracy in patients presenting with gastrointestinal symptoms or an increase in FIT sensitivity by aspirin use [ 27 30 ]. There is also uncertainty about the optimum dose for low-dose aspirin use in the prevention of colorectal cancer.…”

Section: Discussionmentioning

confidence: 99%

Development and user-testing of a brief decision aid for aspirin as a preventive approach alongside colorectal cancer screening

Semedo

Lifford

Edwards

et al. 2021

BMC Med Inform Decis Mak

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Background Several epidemiological and cohort studies suggest that regular low-dose aspirin use independently reduces the long-term incidence and risk of colorectal cancer deaths by approximately 20%. However, there are also risks to aspirin use, mainly gastrointestinal bleeding and haemorrhagic stroke. Making informed decisions depends on the ability to understand and weigh up benefits and risks of available options. A decision aid to support people to consider aspirin therapy alongside participation in the NHS bowel cancer screening programme may have an additional impact on colorectal cancer prevention. This study aims to develop and user-test a brief decision aid about aspirin to enable informed decision-making for colorectal screening-eligible members of the public. Methods We undertook a qualitative study to develop an aspirin decision aid leaflet to support bowel screening responders in deciding whether to take aspirin to reduce their risk of colorectal cancer. The iterative development process involved two focus groups with public members aged 60–74 years (n = 14) and interviews with clinicians (n = 10). Interviews (n = 11) were used to evaluate its utility for decision-making. Analysis was conducted using a framework approach. Results Overall, participants found the decision aid acceptable and useful to facilitate decision-making. They expressed a need for individualised risk information, more detail about the potential risks of aspirin, and preferred risk information presented in pictograms when offered different options. Implementation pathways were discussed, including the possibility of involving different clinicians in the process such as GPs and/or community pharmacists. A range of potentially effective timepoints for sending out the decision aid were identified. Conclusion An acceptable and usable decision aid was developed to support decisions about aspirin use to prevent colorectal cancer.

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Effect of anticoagulants and NSAIDs on accuracy of faecal immunochemical tests (FITs) in colorectal cancer screening: a systematic review and meta-analysis

Cited by 32 publications

References 36 publications

Use of Antiplatelet Agents Decreases the Positive Predictive Value of Fecal Immunochemical Tests for Colorectal Cancer but Does Not Affect Their Sensitivity

Use of Antiplatelet Agents Decreases the Positive Predictive Value of Fecal Immunochemical Tests for Colorectal Cancer but Does Not Affect Their Sensitivity

Setting up a service for a faecal immunochemical test for haemoglobin (FIT): a review of considerations, challenges and constraints

Development and user-testing of a brief decision aid for aspirin as a preventive approach alongside colorectal cancer screening

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