Effects of Oral Anticoagulant and Antiplatelet Agents on Performance of Multitarget Colorectal Cancer Screening Test∗

Abstract

Background and Aims

The multitarget stool DNA (mt-sDNA) test is a noninvasive screening tool for colorectal cancer. We aimed to clarify the effects of antiplatelet and anticoagulant medications on the diagnostic performance of this test.

Methods

We retrospectively identified patients undergoing mt-sDNA testing from Mayo Clinic sites across the US during a 5-year period. Participants with positive stool testing results and subsequent high-quality colonoscopy were included. Participants were grouped by medication use: antiplatelets, anticoagulants, both, or none of these medications. The primary outcomes were the effects on positive predictive value (PPV) of the test for identifying advanced adenoma by antithrombotic use.

Results

Of the 11,761 persons with a positive mt-sDNA test result, 8926 persons (age range, 45–91 years) underwent colonoscopy at our institution, of which 7750 were deemed high quality. Among these, 2435 patients were diagnosed with advanced adenomas, for a PPV of 31.4% for detecting advanced adenomas with the mt-sDNA test. The PPVs for advanced adenoma were 32.1% in nonantithrombotic users, 29.2% in antiplatelet users, 30.9% in anticoagulant users, and 31.7% in users of both medications. Additionally, among all patients with positive mt-sDNA testing and subsequent follow-up colonoscopy (n = 8926), colorectal cancer developed in 116 patients, for a notable 1.3% risk of cancer after positive test results and colonoscopy.

Conclusion

In a large retrospective cohort in the US, the PPV of mt-sDNA testing for advanced adenomas was 31.4%. Use of antiplatelet or anticoagulant agents did not affect the PPV for detection of advanced adenomas.