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Impact of antiplatelet agents and anticoagulants on the performance of fecal immunochemical tests: a systematic review and meta-analysis

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Abstract

Background

Antithrombotic agents may increase the bleeding tendency and affect the performance of fecal immunochemical test (FIT). We aimed to evaluate the impact of antithrombotic agents on the performance of FIT through a systematic review and meta-analysis.

Methods

All relevant studies published between January 1980 and September 2020 that examined the diagnostic performance of FIT were searched through MEDLINE, EMBASE, and Cochrane Library databases. We performed a meta-analysis for the positive predictive value (PPV) of FIT for detecting advanced colorectal neoplasia (ACRN) or colorectal cancer (CRC) according to the administration of antithrombotic agents including aspirin, antiplatelet agents, and oral anticoagulants (OACs).

Results

Thirteen studies with 27,518 patients were included. Of these, 11 studies with data required for the calculation of pooled PPV were included in the meta-analysis. The pooled PPV of FIT for detecting ACRN was significantly lower in antithrombotic agent users than in non-users (odds ratio [OR] [95% confidence interval [CI]]: aspirin, 0.82 [0.68–0.99]; antiplatelet agents, 0.82 [0.69–0.96]; OACs, 0.66 [0.52–0.84]). For detecting CRC, antithrombotic agent use tended to be associated with a reduced PPV (aspirin, 0.76 [0.51–1.14]; antiplatelet agents, 0.73 [0.52–1.02]; OACs, 0.60 [0.25–1.44]). In the subgroup analysis, a FIT cutoff value of 15 μg Hb/g feces tended to be associated with lower PPVs compared to a value of 20 μg Hb/g feces in antithrombotic agent users.

Conclusions

Aspirin, antiplatelet agents, and OACs significantly lowered the PPV of FIT for detecting ACRN. These drugs may increase the false-positive of FIT.

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Acknowledgements

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Author notes

  1. Yoon Suk Jung and Eui Im have contributed equally to this work.

Authors and Affiliations

  1. Department of Internal Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea

    Yoon Suk Jung

  2. Division of Cardiology, Department of Internal Medicine, Yongin Severance Hospital, Yonsei University College of Medicine and Cardiovascular Center, Yongin, Republic of Korea

    Eui Im

  3. Department of Internal Medicine, Hanyang University Guri Hospital, Hanyang University College of Medicine, 153 Gyeongchun-ro, Guri, 11923, Republic of Korea

    Chan Hyuk Park

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  1. Yoon Suk Jung
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Correspondence to Chan Hyuk Park.

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Yoon Suk Jung, Eui Im, and Chan Hyuk Park have no conflicts of interest or financial ties to disclose.

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Supplementary Information

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464_2021_8774_MOESM1_ESM.tif

Supplementary file1 Forest plots of the PPV of FIT for predicting ACRN according to the different cutoff values. Antiplatelet agents include aspirin and NAAA such as clopidogrel, prasugrel, and ticagrelor.PPV positive predictive value; FIT fecal immunochemical test; ACRN advanced colorectal neoplasia; NAAA non-aspirin antiplatelet agent; OAC oral anticoagulant; SE standard error; IV inverse variance; CI confidence interval (TIF 936 kb)

464_2021_8774_MOESM2_ESM.tif

Supplementary file2 Funnel plot for analysis of publication bias in the comparison of the PPV of FIT for detecting ACRN between antiplatelet agent users and non-users. White circle represents observed studies. White diamond represents the pooled logarithmic odds ratio with the 95% confidence interval among the observed studies. P-value was calculated using Egger’s regression test. PPV positive predictive value; FIT fecal immunochemical test; ACRN advanced colorectal neoplasia (TIF 145 kb)

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Jung, Y.S., Im, E. & Park, C.H. Impact of antiplatelet agents and anticoagulants on the performance of fecal immunochemical tests: a systematic review and meta-analysis. Surg Endosc 36, 4299–4311 (2022). https://doi.org/10.1007/s00464-021-08774-7

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