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

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

• Luis Bujanda, MD, PhD
, 
• Ángel Lanas, MD, PhD
, 
• Enrique Quintero, MD, PhD
, 
• Antoni Castells, MD, PhD
, 
• Cristina Sarasqueta, MD
,
• Joaquín Cubiella, MD, PhD
, 
• Vicent Hernandez, MD, PhD
, 
• Juan D. Morillas, MD, PhD
, 
• Teresa Perez-Fernández, MD
, 
• Dolores Salas, MD
,
• Montserrat Andreu, MD, PhD
, 
• Fernando Carballo, MD, PhD
, 
• Xavier Bessa, MD, PhD
, 
• Angel Cosme, MD, PhD
, 
• Rodrigo Jover, MD, PhD
, 
• COLONPREV Study Investigators

published online 10 June 2013.

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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

Abbreviations and Acronyms: AA, advanced adenoma, AN, advanced neoplasia, CRC, colorectal cancer, DAPT, dual antiplatelet therapy, FIT, fecal immunochemical test, NAAA, nonaspirin antiplatelet agent, NAN, nonadvanced neoplasia, PPV, positive predictive value