In a recent paper published in Gastroenterology, author Kristin Ranheim Randel found that common medications such as aspirin and oral anticoagulants affect the performance of the fecal immunochemical test (FIT) for colorectal cancer. The paper was co-authored by Øyvind Holme and Michael Bretthauer at Clinical effectiveness research group, University of Oslo, Thomas de Lange, Geir Hoff, Svein Oskar Frigstad, Katrine Romstad and Edoardo Botteri.
The paper ”Effects of Oral Anticoagulants and Aspirin on Performance of Fecal Immunochemical Tests in Colorectal Cancer Screening” used data from 1367 users and matched non-users from an ongoing colorectal cancer screening trial in Norway. The authors found that both aspirin, and in particular Direct-Acting Oral Anticoagulants (DOACs) lowers the positive predictive value of fecal testing for occult blood. This finding may impact the current colorectal cancer screening guideline recommendations that do not advocate stopping these medications prior to fecal testing. However, the risk of pausing the use of anticoagulants may be harmful for the patient. Norwegian guidelines will therefore not recommend patients to stop taking their anticoagulants prior to fecal testing.